BackgroundIn osteoporotic vertebral compression fractures, supplementation using vitamin D preparations and maintenance of blood vitamin D level within the normal range are necessary for proper fracture union, enhancement of muscle strength, and maintenance of body balance. The purpose of this study is to investigate the effects of vitamin D supplementation on blood vitamin D level, pain relief, union time, and functional outcome in patients with osteoporotic vertebral compression fracture and vitamin D deficiency.Methods130 patients who deficient blood vitamin D level and had osteoporotic vertebral compression fracture were divided into a supplementation group and non-supplementation group. At initial, 3 months, 6 months and 12 months after the injury, radiographs were taken to assess fracture union, and questionnaire were evaluated to evaluate the functional outcome and quality of life.ResultsThe mean age of the 130 patients (36 males and 94 females) was 74.75 ± 7.25 years. There were no statistically significant differences in initial severity of low back pain, functional outcome, and quality of life between the insufficient group and deficient group (all p values were >0.05). There was no significant time-by-group interaction between the supplementation group and non-supplementation group (p = 0.194). In terms of SF-36 physical component score, there was no significant time-by-group interaction between the supplementation group and non-supplementation group (p = 0.934).ConclusionsFracture union was achieved in all patients regardless of serum vitamin D level, and there were significant improvements in severity of low back pain, functional outcome, and quality of life over 12 months in patients with osteoporotic vertebral compression fracture. Short-term vitamin D supplementation of patients with osteoporotic vertebral compression fracture and deficiency of vitamin D did not result in significant differences in fracture union status, functional outcome, and quality of life between the supplementation groups and non-supplementation groups of patients
Study Design:
Retrospective study with prospectively collected data.
Objective:
The purpose of this study is to investigate the difference in fusion rate and clinical outcome of patients with local bone as filler for the graft and demineralized bone matrix (DBM) plus only the cancellous bone from local bone as a filler for cage in 1-level posterior lumbar interbody fusion (PLIF) with cage.
Summary of Background Data:
Cancellous bone is more advantageous than cortical bone in the local bone for improving bone formation in spine fusion surgery. There are little studies on the difference in fusion rate and reduction of fusion time using only these cancellous bones.
Methods:
Of the 40 patients who underwent 1-level PLIF using cage, 20 patients in group A used local bone and 20 patients in group B used mixture of cancellous bone extracted separately from local bone and commercially available DBM as filler for cage. Changes in fusion rate and intervertebral spacing were measured using lateral radiography, and fusion was determined as nonunion using the Brantigan-Steffee classification. The clinical outcome was evaluated.
Results:
There was no difference in height change over time between the two groups. Regarding union grade, group B showed better union grade than group A. However, no difference in union grade change over time was observed between the 2 groups. In group B, Oswestry Disability Index (ODI), Rolland-Morris Disability Questionnaire (RMDQ), and SF-36 mental component score (MCS) significantly decreased, but there was no difference in change over time.
Conclusions:
In 1-level PLIF for degenerative lumbar disease, better fusion rate was observed in the group that used only cancellous bone from local bone plus DBM than that in the group that used local bone; however, there was no difference in fusion grade change over time in the 2 groups.
Currently, it is quite difficult to determine the best timeframe of operative treatment, as well as conduct surgery on asymptomatic COVID-19 patients due to misunderstandings and unawareness of the patient’s inflammation state. Caution needs to be taken in specific patient cohorts, particularly those with femoral shaft fractures, who are more likely to develop diseases like acute respiratory distress syndrome after a procedure like intramedullary nailing. In this case report, a 36-year-old patient suffered a motorcycle accident in which he suffered an ipsilateral femoral shaft and neck fracture of the hip. The patient’s screening test for COVID-19 was positive before admission. Because the patient did not display any COVID-19-related symptoms upon arrival to the hospital, surgical fixation with a reamed intramedullary femoral nail was performed. Despite having a successful post-surgical outcome, the patient was diagnosed with acute respiratory distress syndrome 36 h after surgery, recovering fully after about 2 weeks. To prevent subsequent complications such as acute respiratory distress syndrome in a high inflammatory state patient like COVID-19, the respiratory status and the degree of systemic inflammation should be considered precisely when determining the surgical timing and method.
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