This study presents the literature review on vertebral endplate (EP) changes, which are frequently observed in patients with chronic low back pain (LBP). The disc, EP, and bone marrow region of the spine form a single anatomical and functional interdependent unit; isolated degeneration of any one structure is rare. The cartilaginous EP supported by a bony EP is responsible for anatomical integrity and controls diffusion, the only source of nutrition to the disc. A break in the EP establishes disc-bone marrow contact leading to possible severe autoimmune inflammation and also neovascularization and destruction of the disc. Conversely, degeneration, herniation, or infection of the disc will end in the destruction of both EPs as well as involve the subchondral bone. It is then logical that this region must be considered together as a whole. To consider any one of them in isolation can lead to the error of overlooking changes in the other structures of the disc EP bone marrow complex. Modic changes are discussed extensively in the literature from various angles of being a separate clinical phenotype, having a controversial etiology with the possibility of subclinical infection and treatment with antibiotics, having poor outcomes, and having higher complication rates after surgery. This review article highlights our understanding of vertebral EP changes and progression from Modic classification to disc EP bone marrow complex classification with more clearer depiction of its natural course and clinical implication in LBP.
本研究综述了有关椎体终板（EP）变化的文献，慢性腰背痛（LBP）患者经常出现椎体终板变化。脊柱的椎间盘、椎体终板和骨髓区在解剖和功能上构成了一个相互依存的整体，任何一个结构的单独退化都是罕见的。由骨质 EP 支撑的软骨 EP 负责解剖学上的完整性并控制扩散，这是椎间盘唯一的营养来源。EP的断裂会造成椎间盘与骨髓的接触，从而可能导致严重的自身免疫性炎症以及新生血管形成和椎间盘的破坏。相反，椎间盘的退化、突出或感染将导致两个EP的破坏，并涉及软骨下骨。因此，必须将这一区域作为一个整体来考虑。孤立地考虑其中任何一个因素都可能导致错误，即忽视椎间盘EP骨髓复合体其他结构的变化。文献从不同角度对莫迪区病变进行了广泛的讨论，包括莫迪区病变是一种独立的临床表型、病因存在争议，可能存在亚临床感染和抗生素治疗、疗效不佳以及术后并发症发生率较高等。这篇综述文章强调了我们对椎体EP改变的理解，以及从Modic分类到椎间盘EP骨髓复合体分类的进展，更清晰地描述了其自然病程和对腰痛的临床影响。
{"title":"Vertebral Endplate Changes: Insights Into Its Natural Course and Clinical Implications in Low Back Pain","authors":"S. Rajasekaran, Karthik Ramachandran","doi":"10.4103/isj.isj_36_24","DOIUrl":"https://doi.org/10.4103/isj.isj_36_24","url":null,"abstract":"\u0000 This study presents the literature review on vertebral endplate (EP) changes, which are frequently observed in patients with chronic low back pain (LBP). The disc, EP, and bone marrow region of the spine form a single anatomical and functional interdependent unit; isolated degeneration of any one structure is rare. The cartilaginous EP supported by a bony EP is responsible for anatomical integrity and controls diffusion, the only source of nutrition to the disc. A break in the EP establishes disc-bone marrow contact leading to possible severe autoimmune inflammation and also neovascularization and destruction of the disc. Conversely, degeneration, herniation, or infection of the disc will end in the destruction of both EPs as well as involve the subchondral bone. It is then logical that this region must be considered together as a whole. To consider any one of them in isolation can lead to the error of overlooking changes in the other structures of the disc EP bone marrow complex. Modic changes are discussed extensively in the literature from various angles of being a separate clinical phenotype, having a controversial etiology with the possibility of subclinical infection and treatment with antibiotics, having poor outcomes, and having higher complication rates after surgery. This review article highlights our understanding of vertebral EP changes and progression from Modic classification to disc EP bone marrow complex classification with more clearer depiction of its natural course and clinical implication in LBP.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"97 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intradural spinal tuberculoma is a rare entity, constituting <5% of CNS tuberculoma, whereas intradural extramedullary tuberculoma of spinal cord (IETSC) is even less frequently encountered. Here, we report a case of IETSC at two noncontiguous levels in spinal cord presenting with compressive myelopathy in a patient on multidrug-resistant tuberculosis (MDR-TB) treatment. Surgical decompression and appropriate ATT regimen resulted in gradual return to near-normal neurological function with no functional disability. To our knowledge, this is the first case report of IETSC developing in an immunocompetent patient on MDR regimen for drug resistant sputum-positive pulmonary tuberculosis.
脊髓硬膜内结核瘤是一种罕见的实体瘤，在中枢神经系统结核瘤中所占比例小于 5%，而脊髓硬膜外结核瘤（IETSC）则更少见。在此，我们报告了一例脊髓两个非连续水平的髓外结核瘤病例，患者在接受耐多药结核（MDR-TB）治疗后出现压迫性脊髓病变。通过手术减压和适当的 ATT 治疗，患者的神经功能逐渐恢复至接近正常水平，且未出现功能障碍。据我们所知，这是首例免疫功能正常的患者在接受耐药痰液阳性肺结核 MDR 治疗后出现 IETSC 的病例报告。
{"title":"Delayed Presentation of Intradural Extramedullary Tuberculoma of Spine in an Immunocompetent MDR-TB Patient","authors":"Nishant Saurabh, Vetri Nallathambi","doi":"10.4103/isj.isj_33_23","DOIUrl":"https://doi.org/10.4103/isj.isj_33_23","url":null,"abstract":"\u0000 Intradural spinal tuberculoma is a rare entity, constituting <5% of CNS tuberculoma, whereas intradural extramedullary tuberculoma of spinal cord (IETSC) is even less frequently encountered. Here, we report a case of IETSC at two noncontiguous levels in spinal cord presenting with compressive myelopathy in a patient on multidrug-resistant tuberculosis (MDR-TB) treatment. Surgical decompression and appropriate ATT regimen resulted in gradual return to near-normal neurological function with no functional disability. To our knowledge, this is the first case report of IETSC developing in an immunocompetent patient on MDR regimen for drug resistant sputum-positive pulmonary tuberculosis.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"385 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Moving From Inconsequential to Relevant Publishing","authors":"S. Rajasekaran, K. V. Menon, R. Kanna","doi":"10.4103/isj.isj_60_24","DOIUrl":"https://doi.org/10.4103/isj.isj_60_24","url":null,"abstract":"","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"8 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Dave, Rohan Killekar, A. Krishnan, Devanand Degulmadi, S. Mayi, Mirant R Dave
Atlanto-axial osteoarthritis (AAOA) is a degenerative cervical spine disorder predominantly affecting the elderly. The patients typically present with cervico-occipital pain and restricted and painful neck rotations. The condition is primarily diagnosed with an open-mouth view radiograph, and conservative management is the mainstay of treatment. This study aimed to evaluate the effectiveness of conservative management and a novel technique of greater occipital nerve (GON) block in AAOA and assess the radiographic changes in facet angles and autofusion of the facet joints following conservative management. This study was conducted in patients with AAOA. Pre- and post-treatment visual analog scale (VAS) and neck disability index (NDI) scores were compared to evaluate clinical improvement following conservative treatment. Additionally, the radiographs were also assessed for changes in the facet angles observed in AAOA. Data analysis was performed using SPSS version 25.0 (IBM, Chicago, IL, USA). Statistical tests including paired t tests and correlation coefficients were used. The atlanto-axial facet angle was significantly reduced on the affected side (P < 0.001) compared to the unaffected side. GON block significantly improved VAS and NDI scores (P < 0.001). Auto-fusion of the arthritic facet joint was observed in 15.47% of patients following conservative treatment. Conservative management is the mainstay of AAOA treatment, effectively alleviating pain and improving the quality of life in the affected individuals.
{"title":"Radiographic Assessment and Clinical Outcomes of Conservative Management in Atlanto-Axial Osteoarthritis: A Study of 108 Patients","authors":"B. Dave, Rohan Killekar, A. Krishnan, Devanand Degulmadi, S. Mayi, Mirant R Dave","doi":"10.4103/isj.isj_71_23","DOIUrl":"https://doi.org/10.4103/isj.isj_71_23","url":null,"abstract":"\u0000 \u0000 \u0000 Atlanto-axial osteoarthritis (AAOA) is a degenerative cervical spine disorder predominantly affecting the elderly. The patients typically present with cervico-occipital pain and restricted and painful neck rotations. The condition is primarily diagnosed with an open-mouth view radiograph, and conservative management is the mainstay of treatment. This study aimed to evaluate the effectiveness of conservative management and a novel technique of greater occipital nerve (GON) block in AAOA and assess the radiographic changes in facet angles and autofusion of the facet joints following conservative management.\u0000 \u0000 \u0000 \u0000 This study was conducted in patients with AAOA. Pre- and post-treatment visual analog scale (VAS) and neck disability index (NDI) scores were compared to evaluate clinical improvement following conservative treatment. Additionally, the radiographs were also assessed for changes in the facet angles observed in AAOA. Data analysis was performed using SPSS version 25.0 (IBM, Chicago, IL, USA). Statistical tests including paired t tests and correlation coefficients were used.\u0000 \u0000 \u0000 \u0000 The atlanto-axial facet angle was significantly reduced on the affected side (P < 0.001) compared to the unaffected side. GON block significantly improved VAS and NDI scores (P < 0.001). Auto-fusion of the arthritic facet joint was observed in 15.47% of patients following conservative treatment.\u0000 \u0000 \u0000 \u0000 Conservative management is the mainstay of AAOA treatment, effectively alleviating pain and improving the quality of life in the affected individuals.\u0000","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"248 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Muthu, Vibhu Krishnan Visawanathan, Girinivasan Chellamuthu
The etiology of degenerative disk disease (DDD) is multifactorial. Among the various factors, mechanical processes contributing to endplate or discal injuries have been discussed as the initiating events in the degenerative cascade. DDD encompasses the multitudinous changes undergone by the different structures of the spinal segment, namely intervertebral disk (IVD), facet joints, vertebral end plate (VEP), adjoining marrow (Modic changes), and vertebral body. It has been etiologically linked to a complex interplay of diverse mechanisms. Mechanically, two different mechanisms have been proposed for intervertebral disk degeneration (IVDD): endplate-driven, especially in upper lumbar levels, and annulus-driven degeneration. VEP is the weakest link of the lumbar spine, and fatigue damage can be inflicted upon them under physiological loads, leading to the initiation of DDD. Disk calcification has been put forth as another initiator of inflammation, stiffening, and abnormal stresses across the IVD. The initial mechanical disruption leads to secondary IVDD through unfavorable loading of the nucleus pulposus and annulus fibrosis. The final degenerative cascade is then propagated through a combination of biological, inflammatory, autoimmune, or metabolic pathways (impaired transport of metabolites or nutrients). Abnormal spinopelvic alignment, especially pelvic incidence, also significantly impacts the degenerative process. Hence, the etiology of DDD is multifactorial. Mechanical pathways, including VEP injuries, increased disk stiffness, and abnormal spinopelvic alignment, play a significant role in the initiation of IVDD.
{"title":"Mechanical Basis of Lumbar Intervertebral Disk Degeneration","authors":"S. Muthu, Vibhu Krishnan Visawanathan, Girinivasan Chellamuthu","doi":"10.4103/isj.isj_6_24","DOIUrl":"https://doi.org/10.4103/isj.isj_6_24","url":null,"abstract":"\u0000 The etiology of degenerative disk disease (DDD) is multifactorial. Among the various factors, mechanical processes contributing to endplate or discal injuries have been discussed as the initiating events in the degenerative cascade. DDD encompasses the multitudinous changes undergone by the different structures of the spinal segment, namely intervertebral disk (IVD), facet joints, vertebral end plate (VEP), adjoining marrow (Modic changes), and vertebral body. It has been etiologically linked to a complex interplay of diverse mechanisms. Mechanically, two different mechanisms have been proposed for intervertebral disk degeneration (IVDD): endplate-driven, especially in upper lumbar levels, and annulus-driven degeneration. VEP is the weakest link of the lumbar spine, and fatigue damage can be inflicted upon them under physiological loads, leading to the initiation of DDD. Disk calcification has been put forth as another initiator of inflammation, stiffening, and abnormal stresses across the IVD. The initial mechanical disruption leads to secondary IVDD through unfavorable loading of the nucleus pulposus and annulus fibrosis. The final degenerative cascade is then propagated through a combination of biological, inflammatory, autoimmune, or metabolic pathways (impaired transport of metabolites or nutrients). Abnormal spinopelvic alignment, especially pelvic incidence, also significantly impacts the degenerative process. Hence, the etiology of DDD is multifactorial. Mechanical pathways, including VEP injuries, increased disk stiffness, and abnormal spinopelvic alignment, play a significant role in the initiation of IVDD.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Degenerative disc disease (DDD) is a prevalent musculoskeletal disorder characterized by the progressive degeneration of intervertebral discs, often leading to chronic low back pain and disability. While the etiology of DDD is multifactorial, genetic factors play a significant role in disease susceptibility and progression. This review provides a comprehensive overview of the genetic aspects of DDD, summarizing previously reported genes and variations associated with the disease. Through an analysis of animal studies and molecular pathways implicated in disc degeneration, including the lipid kinase phoshoinositide-3-kinase signaling pathway (PI3K-Akt), mitogen-activated protein kinase/extracellular signal-regulated kinase signaling pathway (MAPK-ERK), Wingless-related integration (Wnt)/β-catenin, Sonic Hedgehog (Shh), and mammalian target of rapamycin (mTOR) pathways, this review elucidates the intricate interplay between genetic factors and disc pathology. Several candidate genes have been identified in association with DDD, including those involved in extracellular matrix regulation, inflammation, and cell signaling. Genome-wide association studies have further expanded our understanding of the genetic architecture underlying DDD, revealing novel susceptibility loci and pathways. Animal studies utilizing genetically modified models have provided valuable insights into the molecular mechanisms driving disc degeneration and have validated the relevance of specific genetic pathways in disease pathogenesis. Understanding the genetic basis of DDD holds promise for identifying individuals at risk, developing predictive biomarkers, and informing personalized treatment approaches. Furthermore, elucidating the molecular pathways involved in disc degeneration may lead to the identification of novel therapeutic targets for DDD management. Overall, this review consolidates current knowledge on DDD genetics and pathways, providing a foundation for future research endeavors aimed at unraveling the intricate genetic mechanisms underlying this prevalent musculoskeletal disorder.
{"title":"Decoding the Genetic Threads of Disc Degeneration","authors":"Amitabh Biswas, B. Garg","doi":"10.4103/isj.isj_26_24","DOIUrl":"https://doi.org/10.4103/isj.isj_26_24","url":null,"abstract":"\u0000 Degenerative disc disease (DDD) is a prevalent musculoskeletal disorder characterized by the progressive degeneration of intervertebral discs, often leading to chronic low back pain and disability. While the etiology of DDD is multifactorial, genetic factors play a significant role in disease susceptibility and progression. This review provides a comprehensive overview of the genetic aspects of DDD, summarizing previously reported genes and variations associated with the disease. Through an analysis of animal studies and molecular pathways implicated in disc degeneration, including the lipid kinase phoshoinositide-3-kinase signaling pathway (PI3K-Akt), mitogen-activated protein kinase/extracellular signal-regulated kinase signaling pathway (MAPK-ERK), Wingless-related integration (Wnt)/β-catenin, Sonic Hedgehog (Shh), and mammalian target of rapamycin (mTOR) pathways, this review elucidates the intricate interplay between genetic factors and disc pathology. Several candidate genes have been identified in association with DDD, including those involved in extracellular matrix regulation, inflammation, and cell signaling. Genome-wide association studies have further expanded our understanding of the genetic architecture underlying DDD, revealing novel susceptibility loci and pathways. Animal studies utilizing genetically modified models have provided valuable insights into the molecular mechanisms driving disc degeneration and have validated the relevance of specific genetic pathways in disease pathogenesis. Understanding the genetic basis of DDD holds promise for identifying individuals at risk, developing predictive biomarkers, and informing personalized treatment approaches. Furthermore, elucidating the molecular pathways involved in disc degeneration may lead to the identification of novel therapeutic targets for DDD management. Overall, this review consolidates current knowledge on DDD genetics and pathways, providing a foundation for future research endeavors aimed at unraveling the intricate genetic mechanisms underlying this prevalent musculoskeletal disorder.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"7 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lumbar canal stenosis (LCS) is characterized by narrowing of the central spinal canal or lateral recesses and foramina, leading to compression of nerve tissues. It causes neurogenic claudication, which manifests as back pain and variety of lower limb symptoms such as pain, tingling/numbness, or paresthesia on ambulation. A rare symptom of LCS is priapism, which is thought to occur due to parasympathetic dysfunction. We describe a case of a 45-year-old man, who presented with neurogenic claudication and intermittent priapism due to lumbar intervertebral disc prolapse, which resolved completely after surgical decompression, and literature review for the same.
{"title":"A rare case of priapism secondary to intervertebral disc prolapse: Case report and literature review","authors":"Sharvin Sheth, Amit Jhala","doi":"10.4103/isj.isj_76_22","DOIUrl":"https://doi.org/10.4103/isj.isj_76_22","url":null,"abstract":"Lumbar canal stenosis (LCS) is characterized by narrowing of the central spinal canal or lateral recesses and foramina, leading to compression of nerve tissues. It causes neurogenic claudication, which manifests as back pain and variety of lower limb symptoms such as pain, tingling/numbness, or paresthesia on ambulation. A rare symptom of LCS is priapism, which is thought to occur due to parasympathetic dysfunction. We describe a case of a 45-year-old man, who presented with neurogenic claudication and intermittent priapism due to lumbar intervertebral disc prolapse, which resolved completely after surgical decompression, and literature review for the same.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"167 - 170"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41495878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence in spine surgery: The new kid on the block","authors":"M. Chadha, R. Arora, Anil Jain","doi":"10.4103/isj.isj_50_23","DOIUrl":"https://doi.org/10.4103/isj.isj_50_23","url":null,"abstract":"","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"115 - 117"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43884970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Dave, Shivakumar A Bali, D. Degulmadi, A. Krishnan, S. Mayi, Raviranjan Rai
Objective: The purpose of the study was to evaluate the efficacy and safety of therapy with nandrolone decanoate and alendronate compared with alendronate monotherapy in patients with osteoporosis. Materials and Methods: Osteoporotic patients with T scores less than or equal to -2.5 (World Health Organization) either at lumbar vertebrae or hip, fulfilling inclusion criteria were enrolled in the study. Patients were randomized into two groups. Patients in group A were administered injection of Deca Durabolin (nandrolone decanoate) 50-mg intramuscular every 3 weeks for 12 weeks followed by every 4 weeks for the next 36 weeks along with alendronate 70 mg per oral (p.o) every week for 48 weeks. Patients in group B received only alendronate 70 mg (p.o) for 48 weeks. Follow-up was done at 3, 6, and 12 months for clinical evaluation and answering the questionnaire. Results: A total of 230 patients with the mean age of 60 years were enrolled in the study. At the end of 1 year, 53 patients were lost to follow‑up, and 177 patients were included in the study analysis. Enrolled patients were randomized to group A (n = 89) and group B (n = 88). Patients in group A had significantly higher improvement in bone mineral density (BMD) of lumbar spine, frailty score, quality-of-life (QOL) score compared with patients in group B. Patients in both groups had improvement in BMD of hip, lean mass, body fat, Oswestry disability index, and visual analog score but it was not statistically significant on the intergroup comparison. Conclusion: Our results demonstrate that the addition of nandrolone decanoate to alendronate therapy increases lumbar spine BMD. Improvement in bone quality also translates into an improvement in patient-related outcome measures such as QOL and frailty scores.
{"title":"An academic clinical study to assess the efficacy and safety of nandrolone decanoate and alendronate compared with alendronate alone in patients with osteoporosis","authors":"B. Dave, Shivakumar A Bali, D. Degulmadi, A. Krishnan, S. Mayi, Raviranjan Rai","doi":"10.4103/isj.isj_2_23","DOIUrl":"https://doi.org/10.4103/isj.isj_2_23","url":null,"abstract":"Objective: The purpose of the study was to evaluate the efficacy and safety of therapy with nandrolone decanoate and alendronate compared with alendronate monotherapy in patients with osteoporosis. Materials and Methods: Osteoporotic patients with T scores less than or equal to -2.5 (World Health Organization) either at lumbar vertebrae or hip, fulfilling inclusion criteria were enrolled in the study. Patients were randomized into two groups. Patients in group A were administered injection of Deca Durabolin (nandrolone decanoate) 50-mg intramuscular every 3 weeks for 12 weeks followed by every 4 weeks for the next 36 weeks along with alendronate 70 mg per oral (p.o) every week for 48 weeks. Patients in group B received only alendronate 70 mg (p.o) for 48 weeks. Follow-up was done at 3, 6, and 12 months for clinical evaluation and answering the questionnaire. Results: A total of 230 patients with the mean age of 60 years were enrolled in the study. At the end of 1 year, 53 patients were lost to follow‑up, and 177 patients were included in the study analysis. Enrolled patients were randomized to group A (n = 89) and group B (n = 88). Patients in group A had significantly higher improvement in bone mineral density (BMD) of lumbar spine, frailty score, quality-of-life (QOL) score compared with patients in group B. Patients in both groups had improvement in BMD of hip, lean mass, body fat, Oswestry disability index, and visual analog score but it was not statistically significant on the intergroup comparison. Conclusion: Our results demonstrate that the addition of nandrolone decanoate to alendronate therapy increases lumbar spine BMD. Improvement in bone quality also translates into an improvement in patient-related outcome measures such as QOL and frailty scores.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"146 - 151"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44068225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pars interarticularis defects leading to spondylolysis and/or spondylolisthesis especially in young athletes are most commonly seen in lower lumbar vertebrae. Conservative treatment with abstinence from the athletic activities, rest, and physiotherapy marks the primary mode of treatment before going to surgical interventions. We report a 26-year-old patient with chronic lower back pain with antecedent history of athletic activities involving javelin throw. Besides an athletic activity, no other history of trauma existed. Radiologic investigations showed skip level pars lysis at L3 and L5 vertebrae. Patient was treated with only conservative methods, abstinence from sports and physiotherapy. Patient had significant improvement in his symptoms. Long-term proper physiotherapy to strengthen the lower back and abdominal muscles is necessary in order to alleviate the symptoms and to regain athletics. To our knowledge there are no reported cases where we find spondylolysis in upper lumbar vertebrae (L3), which is uncommon, along with most common L5 involvement in a young athletic javelin thrower. We have found only isolated L3/L4/L5 or concurrent L3 and L4 or L4 and L5 pars lysis reported in literature. There are no reported cases in literature on skip level spondylolysis in a single individual. Because of the natural history of the disease, conservative methods of management were aptly advocated and positive outcomes were seen in the follow-up.
{"title":"Skip spondylolysis in a javelin thrower: A rare case report","authors":"Haranahalli Bharath, Anuj Gupta, A. Srivastava","doi":"10.4103/isj.isj_41_22","DOIUrl":"https://doi.org/10.4103/isj.isj_41_22","url":null,"abstract":"Pars interarticularis defects leading to spondylolysis and/or spondylolisthesis especially in young athletes are most commonly seen in lower lumbar vertebrae. Conservative treatment with abstinence from the athletic activities, rest, and physiotherapy marks the primary mode of treatment before going to surgical interventions. We report a 26-year-old patient with chronic lower back pain with antecedent history of athletic activities involving javelin throw. Besides an athletic activity, no other history of trauma existed. Radiologic investigations showed skip level pars lysis at L3 and L5 vertebrae. Patient was treated with only conservative methods, abstinence from sports and physiotherapy. Patient had significant improvement in his symptoms. Long-term proper physiotherapy to strengthen the lower back and abdominal muscles is necessary in order to alleviate the symptoms and to regain athletics. To our knowledge there are no reported cases where we find spondylolysis in upper lumbar vertebrae (L3), which is uncommon, along with most common L5 involvement in a young athletic javelin thrower. We have found only isolated L3/L4/L5 or concurrent L3 and L4 or L4 and L5 pars lysis reported in literature. There are no reported cases in literature on skip level spondylolysis in a single individual. Because of the natural history of the disease, conservative methods of management were aptly advocated and positive outcomes were seen in the follow-up.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"181 - 185"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48562853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：