The acromegalic spine: fractures, deformities and spinopelvic balance

Oliveira, Bruno de Azevedo; Araújo, Bruna; Santos, Tainá Mafalda Dos; Ongaratti, Bárbara Roberta; Rech, Carolina Garcia Soares Leães; Ferreira, Nelson Pires; Pereira-Lima, Júlia Fernanda Semmelmann; Oliveira, Miriam da Costa

doi:10.1007/s11102-019-00991-7

Cited by 13 publications

(4 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a result, PKP could not only stable the fractured vertebra body and reveal the severe pain immediately, but also restore the vertebral body height and correct the local kyphosis by inflating of the balloon (6,9,10). However, there is no study investigate the influence of PKP on the (12)(13)(14). In patients with severe sagittal imbalance of entire spine, posterior rotation of the pelvis around the hip joint takes place to compensate for sagittal imbalance even to a small extent and that this compensatory mechanism leads to a decrease in sacral slope and an increase in pelvic tilt.…”

Section: Imaging Results Pre-and Post-operationmentioning

confidence: 99%

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

Li¹,

Zhang²,

Ren³

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose To detect the postoperative change in total spinal alignment in 0VCF patients after PKP. Methods A total of 130 patients with vertebral compression fracture was involved in this study. The entire spine radiographs of every patients were taken pre and postoperatively. The parameters including vertebral body height, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). All the parameters were compared before and after PKP. Results In the patients, the VAS score was decreased from 8.26±1.12 preoperative to 2.70±0.90 postoperative. And SVA decreased from 6.82±3.30 cm to 4.07±2.77cm. The change in sagittal balance is related to the recovery of vertebral body height. Conclusion PKP plays a role not only in improving the vertebral body height but also in rebuilding sagittal imbalance in the treatment of vertebral compression fracture.

show abstract

Section: Imaging Results Pre-and Post-operationmentioning

confidence: 99%

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

Li¹,

Zhang²,

Ren³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Ideally, the lumbar lordosis is within 9° of the pelvic incidence such that lumbar lordosis equals pelvic incidence ±9° [32]. Therefore, a mismatch between pelvic incidence and lumbar lordosis ≥10° was considered as expression of lumbar-pelvic imbalance [14, 32]. The pelvic tilt was defined as the value, in degrees, of the angle created by a line running from the sacral endplate midpoint to the center of the bifemoral heads and the vertical axis; it is dependent on the position of the patient and represents the pelvic retroversion (i.e., the posterior rotation of the pelvis).…”

Section: Methodsmentioning

confidence: 99%

“…Arthropathy is one of the most prevalent and invalidating complications of acromegaly, affecting both weight- and non-weight-bearing joints [12]. Indeed, the spine is often affected by acromegalic arthropathy, and patients frequently present hyperkyphosis [13] and sagittal spine imbalance [14]. Acromegalic patients are also affected by skeletal fragility with high risk of VFs caused by an increase in bone turnover and profound alterations in bone microstructure that are not generally captured by dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density [15].…”

Section: Introductionmentioning

confidence: 99%

Vertebral Fractures Associated with Spinal Sagittal Imbalance and Quality of Life in Acromegaly: A Radiographic Study with EOS 2D/3D Technology

Cellini¹,

Biamonte²,

Mazza³

et al. 2020

Neuroendocrinology

View full text Add to dashboard Cite

Introduction: Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs). Objective: This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain, and disability. Methods: Thirty-eight patients with acromegaly (median age: 55 years, 20 males) and 38 matched control subjects were evaluated by a low-dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy, and spine deformities (Cobb thoracic index ≥40°, pelvic incidence minus lumbar lordosis ≥10°, pelvic tilt >20°, and sagittal vertical axis ≥4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF-36]) and pain and disability (Western Ontario and McMaster University [WOMAC]). Results: Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥40°; p = 0.04) and pelvic tilt >20° (p = 0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p = 0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p = 0.03), pelvic tilt >20° (p = 0.04), sagittal vertical axis ≥4 cm (p = 0.03), and moderate/severe subchondral degeneration (p = 0.01). Moreover, patients with VFs had lower AcroQoL general health (p = 0.007) and SF-36 general health (p = 0.002) scores and higher WOMAC pain (p = 0.003) and global (p = 0.009) scores than patients who did not fracture. Conclusions: In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL, and disability.

show abstract

“…Vertebral fractures (VFs) are a common complication of acromegaly, and contribute to the frequently observed thoracic kyphosis and high prevalence of back pain in these patients [ 1 – 3 ]. Prevalence of radiographic VFs is up to 40% during active disease, with even higher numbers after long-term follow-up in controlled patients (~60%) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Low sclerostin levels after long-term remission of acromegaly

Claessen¹,

Pelsma²,

Kroon

et al. 2021

Endocrine

View full text Add to dashboard Cite

Purpose Bone health is compromised in acromegaly resulting in vertebral fractures (VFs), regardless of biochemical remission. Sclerostin is a negative inhibitor of bone formation and is associated with increased fracture risk in the general population. Therefore, we compared sclerostin concentrations between well-controlled acromegaly patients and healthy controls, and assessed its relationship with bone mineral density (BMD), and VFs in acromegaly. Methods Seventy-nine patients (mean age 58.9 ± 11.4 years, 49% women) with controlled acromegaly, and 91 healthy controls (mean age 51.1 ± 16.9 years, 59% women) were included. Plasma sclerostin levels (pg/mL) in patients were measured with an ELISA assay, whereas in controls, serum levels were converted to plasma levels by multiplication with 3.6. In patients, VFs were radiographically assessed, and BMD was assessed using dual X-ray absorptiometry. Results Median sclerostin concentration in controlled acromegaly patients was significantly lower than in healthy controls (104.5 pg/mL (range 45.7–234.7 pg/mL) vs 140.0 pg/mL (range 44.8–401.6 pg/mL), p < 0.001). Plasma sclerostin levels were not related to age, current growth hormone (GH) or insulin-like factor-1 (IGF-1) levels, gonadal state, treatment modality, remission duration, or BMD, VF presence, severity or progression. Conclusion Patients with long-term controlled acromegaly have lower plasma sclerostin levels than healthy controls, as a reflection of decreased osteocyte activity. Further longitudinal studies are needed to establish the course of sclerostin during different phases of disease and its exact effects in acromegalic osteopathy.

show abstract

The acromegalic spine: fractures, deformities and spinopelvic balance

Cited by 13 publications

References 38 publications

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

The change of sagital balance after PKP for patients with osteoporotic vertebral compression

Vertebral Fractures Associated with Spinal Sagittal Imbalance and Quality of Life in Acromegaly: A Radiographic Study with EOS 2D/3D Technology

Low sclerostin levels after long-term remission of acromegaly

Contact Info

Product

Resources

About