Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors ...are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
Osteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 ...independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation.
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•A multicohort study identifies 52 previously unknown osteoarthritis genetic risk variants•Similarities and differences in osteoarthritis genetic risk depend on joint sites•Osteoarthritis genetic components are associated with pain-related phenotypes•High-confidence effector genes highlight potential targets for drug intervention
A multicohort genome-wide association meta-analysis of osteoarthritis highlights the impact of joint site types on the features of genetic risk variants and the link between osteoarthritis genetics and pain-related phenotypes, pointing toward potential targets for therapeutic intervention.
Summary Background Scoliosis in skeletally immature children is often treated by implantation of a rod to straighten the spine. Rods can be distracted (lengthened) as the spine grows, but patients ...need many invasive operations under general anaesthesia. Such operations are costly and associated with negative psychosocial outcomes. We assessed the effectiveness and safety of a new magnetically controlled growing rod (MCGR) for non-invasive outpatient distractions. Methods We implanted the MCGR in five patients, two of whom have now reached 24 months' follow-up. Each patient underwent monthly outpatient distractions. We used radiography to measure the magnitude of the spinal curvature, rod distraction length, and spinal length. We assessed clinical outcome by measuring the degree of pain, function, mental health, satisfaction with treatment, and procedure-related complications. Findings In the two patients with 24 months' follow-up, the mean degree of scoliosis, measured by Cobb angle, was 67° (SD 10°) before implantation and 29° (4°) at 24 months. Length of the instrumented segment of the spine increased by a mean of 1·9 mm (0·4 mm) with each distraction. Mean predicted versus actual rod distraction lengths were 2·3 mm (1·2 mm) versus 1·4 mm (0·7 mm) for patient 1, and 2·0 mm (0·2 mm) and 2·1 mm (0·7 mm) versus 1·9 mm (0·6 mm) and 1·7 mm (0·8 mm) for patient 2's right and left rods, respectively. Throughout follow-up, both patients had no pain, had good functional outcome, and were satisfied with the procedure. No MCGR-related complications were noted. Interpretation The MCGR procedure can be safely and effectively used in outpatient settings, and minimises surgical scarring and psychological distress, improves quality of life, and is more cost-effective than is the traditional growing rod procedure. The technique could be used for non-invasive correction of abnormalities in other disorders. Funding Ellipse Technologies.
Purpose
The aims of this study were (1) to determine the prevalence of radiographic cervical disc degeneration in a large population of patients aged from 18 to 97 years; (2) to investigate ...individually the prevalence and distribution of height loss, osteophyte formation, endplate sclerosis and spondylolisthesis; and (3) to describe the patterns of cervical disc degeneration.
Methods
A retrospective study was performed. Standard lateral cervical spine radiographs in standing, neutral position of 1581 consecutive patients (723 males, 858 females) with an average age of 41.2 ± 18.2 years were evaluated. Cervical disc degeneration was graded from C2/C3 to C6/C7 based on a validated quantitative grading system. The prevalence and distribution of radiographic findings were evaluated and associations with age were investigated.
Results
53.9% of individuals had radiographic disc degeneration and the most affected level was C5/C6. The presence and severity of disc degeneration were found to be significantly associated with age both in male and female subjects. The most frequent and severe occurrences of height loss, osteophyte formation, and endplate sclerosis were at C5/C6, whereas spondylolisthesis was most observed at C4/C5. Age was significantly correlated with radiographic degenerative findings. Contiguous levels degeneration pattern was more likely found than skipped level degeneration. The number of degenerated levels was also associated with age.
Conclusions
The presence and severity of radiographic disc degeneration increased with aging in the cervical spine. Older age was associated with greater number of degenerated disc levels. Furthermore, the correlations between age and the degree of degenerative findings were stronger at C5/C6 and C6/C7 than at other cervical spinal levels.
Purpose
Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and ...patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool.
Methods
A retrospective, single center study was conducted of 2630 consecutive patients that underwent lumbar microdiscectomy (mean follow-up: 22-months). Various preoperative patient pain/disability/functional profiles, imaging parameters, and anthropomorphic/demographic metrics were noted. An Extreme Gradient Boost (XGBoost) classifier was implemented to develop a predictive model identifying patients at risk for re-HNP. The model was exported to a web application software for clinical utility.
Results
There were 1608 males and 1022 females, 114 of whom experienced re-HNP. Primary herniations were central (65.8%), paracentral (17.6%), and far lateral (17.1%). The XGBoost algorithm identified multiple re-HNP predictors and was incorporated into an open-access web application software, identifying patients at low or high risk for re-HNP. Preoperative VAS leg, disability, alignment parameters, elevated body mass index, symptom duration, and age were the strongest predictors.
Conclusions
Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low–high risk patients for re-HNP. Additional validation is needed for potential global implementation.
Purpose
Modic changes (MC) on magnetic resonance imaging (MRI) have been associated with the development and severity of low back pain (LBP). The etiology of MC remains elusive, but it has been ...suggested that altered metabolism may be a risk factor. As such, this study aimed to identify metabolomic biomarkers for MC phenotypes of the lumbar spine via a combined metabolomic-genomic approach.
Methods
A population cohort of 3,584 southern Chinese underwent lumbar spine MRI. Blood samples were genotyped with single-nucleotide polymorphisms (SNP) arrays (
n
= 2,482) and serum metabolomics profiling using magnetic resonance spectroscopy (
n
= 757), covering 130 metabolites representing three molecular windows, were assessed. Genome-wide association studies (GWAS) were performed on each metabolite, to construct polygenic scores for predicting metabolite levels in subjects who had GWAS but not metabolomic data. Associations between predicted metabolite levels and MC phenotypes were assessed using linear/logistic regression and least absolute shrinkage and selection operator (LASSO). Two-sample Mendelian randomization analysis tested for causal relationships between metabolic biomarkers and MC.
Results
20.4% had MC (10.6% type 1, 67.2% type 2, 22.2% mixed types). Significant MC metabolomic biomarkers were mean diameter of very-low-density lipoprotein (VLDL)/low-density lipoprotein (LDL) particles and cholesterol esters/phospholipids in large LDL. Mendelian randomization indicated that decreased VLDL mean diameter may lead to MC.
Conclusions
This large-scale study is the first to address metabolomics in subject with/without lumbar MC. Causality studies implicate VLDL related to MC, noting a metabolic etiology. Our study substantiates the field of “spino-metabolomics” and illustrates the power of integrating metabolomics-genomics-imaging phenotypes to discover biomarkers for spinal disorders, paving the way for more personalized spine care for patients.
Abstract Background Context Modic changes (MC) are bone marrow lesions on magnetic resonance imaging (MRI), suggestive of being associated with low back pain (LBP). Data on determinants of MC and ...their association with disc degeneration and other spinal phenotypes, as well as that of LBP, rely mostly on small-scale patient populations and remain controversial. Purpose This study addressed the potential determinants of MC and their association with disc degeneration and LBP among Southern Chinese. Study Design/Setting A cross-sectional, population-based study was carried out. Patient Sample This study consisted of 2,449 Southern Chinese volunteers. Methods Sagittal T2-weighted MRIs of the lumbar spine were assessed for the presence of MC and other spinal phenotypes (eg, disc degeneration, disc displacement, Schmorl nodes) in all individuals. Subjects' demographics, occupation, lifestyle, and clinical profiles were assessed. Results The overall prevalence of MC was 5.8% (n=141), which increased with advancing age. Modic changes predominantly occurred at the lowest two lumbar levels (83%). In the multivariate analyses, only the presence of disc displacement and a higher disc degeneration score were associated with MC at the upper lumbar levels (L1/L2–L3/L4) (p<.01). The presence of MC at the lowest two lumbar levels (L4/L5–L5/S1) were associated with age, the presence of Schmorl nodes, disc degeneration or displacement, and historical lumbar injury (p<.01). Subjects who were both smokers and overweight or obese had increased likelihood of MC in the lower spine (OR: 2.18; 95% CI: 1.10–4.30). The presence of MC at the lower lumbar levels were associated with historical LBP (OR: 1.93; 95% CI: 1.05–3.54) and with severity and duration of symptoms (p<.05). Conclusions Based on one of the largest MRI studies to assess lumbar MC, we noted that MC were associated with both disc degeneration and the presence and severity of LBP. Determinants and association of MC with disc degeneration and clinical symptoms in the upper versus the lower lumbar spine were different. Our study further stresses the significance of MC as important imaging phenotypes associated with LBP.
Purpose
Remote patient monitoring (RPM) has revolutionized the landscape of healthcare. From humble beginnings rooted in landline home telephone calls to present-day devices with near instantaneous ...wireless connectivity, the evolution of technology has ushered in an era of digital medicine and remote care. Presently, a vast array of healthcare data points can be automatically generated, analyzed, and forwarded to providers to supplement clinical decision-making. While RPM originated and was popularized within medicine, its role in orthopedics, and particularly within spine surgery, is evolving. We sought to provide an overview of RPM within orthopedics, with specific attention on spine care, analyzing its origins, present-day form, and prospects.
Methods
We reviewed the literature to date as it pertains to RPM within healthcare at large, orthopedics, and spine care.
Results
We detail the development and clinical use of wearable technology and smart implants, examining the underlying technology and evaluating the spectrum of their present-day and potential applications.
Conclusions
Technological advancements are not only reshaping the paradigm of musculoskeletal care but are also redefining the physician–patient relationship as well as reimagining traditional perspectives on healthcare data collection and privacy.
Objective: To review and highlight the historical and recent advances of imaging in spine surgery and to discuss current applications and future directions.Methods: A PubMed review of the current ...literature was performed on all relevant articles that examined historical and recent imaging techniques used in spine surgery. Studies were examined for their thoroughness in description of various modalities and applications in current and future management.Results: We reviewed 97 articles that discussed past, present, and future applications for imaging in spine surgery. Although most historical approaches relied heavily upon basic radiography, more recent advances have begun to expand upon advanced modalities, including the integration of more sophisticated equipment and artificial intelligence.Conclusions: Since the days of conventional radiography, various modalities have emerged and become integral components of the spinal surgeon's diagnostic armamentarium. As such, it behooves the practitioner to remain informed on the current trends and potential developments in spinal imaging, as rapid adoption and interpretation of new techniques may make significant differences in patient management and outcomes. Future directions will likely become increasingly sophisticated as the implementation of machine learning, and artificial intelligence has become more commonplace in clinical practice.
Purpose
To assess the effect of frequent small distractions with a magnetically controlled growing rod (MCGR) on spinal length gain and achieved distraction length in children with early-onset ...scoliosis (EOS), and to determine whether the law of diminishing returns applies to this group of patients with MCGR.
Methods
A consecutive series of 3 males and 4 females with EOS who underwent MCGR implantation at a mean age of 10.2 years and were followed up for a mean of 3.8 years were reviewed. Distraction was aimed at 2 mm monthly. The coronal Cobb angle, T1-S1 length gain, and achieved distraction length were measured at 6-monthly intervals.
Results
The mean total number of distractions was 31. Four of the patients had problems that may have affected distractions. The mean coronal Cobb angle improved post-operatively and was maintained throughout the follow-up period. The mean T1-S1 length gain and achieved distraction length varied over the follow-up period and did not diminish with repeated lengthening.
Conclusions
Frequent small distractions with the MCGR for EOS enable T1-S1 and achieved distraction length gain without significant reduction in gain after repeated lengthening.
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