SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Asian spine journal

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Selective estrogen receptor modulators (SERMs) are now being used as a treatment for breast cancer, osteoporosis and postmenopausal symptoms, as these drugs have features that can act as an estrogen agonist and an antagonist, depending on the target tissue. After tamoxifen, raloxifene, lasofoxifene and bazedoxifene SERMs have been developed and used for treatment. The clinically decisive difference among these drugs (i.e., the key difference) is their endometrial safety. Compared to bisphosphonate drug formulations for osteoporosis, SERMs are to be used primarily in postmenopausal women of younger age and are particularly recommended if there is a family history of invasive breast cancer, as their use greatly reduces the incidence of this type of cancer in women. Among the above mentioned SERMs, raloxifene has been widely used in prevention and treatment of postmenopausal osteoporosis and vertebral compression fractures, and clinical studies are now underway to test the comparative advantages of raloxifene with those of bazedoxifene, a more recently developed SERM. Research on a number of adverse side effects of SERM agents is being performed to determine the long-term safety of this class of compouds for treatment of osteoporosis.

Concepts: Osteoporosis, Pharmacology, Breast cancer, Menopause, Estrogen, Estrogen receptor, Tamoxifen, Selective estrogen receptor modulator

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Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome.

Concepts: Nervous system, Brain, Atherosclerosis, Blood pressure, Medical imaging, Magnetic resonance imaging, Spinal stenosis, Intermittent claudication

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The purpose of this study was to introduce our patient-specific bioactive porous titanium implant manufactured using selective laser melting (SLM) and to establish the efficacy and safety of the implant for stand-alone anterior cervical discectomy and fusion (ACDF) based on a prospective clinical trial. We designed a customized ACDF implant using patient-specific data and manufactured the implant using SLM. We produced a bioactive surface through a specific chemical and thermal treatment. Using this implant, we surgically treated four patients with cervical degenerative disc disease and evaluated the clinical and radiological results. We achieved successful bony union in all but one patient without autologous bone grafting within 1 year. We observed no implant subsidence during the follow-up period, and all clinical parameters improved significantly after surgery, with no reported implant-related adverse effects. Our customized bioactive porous titanium implant is a safe and promising implant for stand-alone ACDF.

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Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms “spinal tuberculosis,” “tuberculous spondylitis,” “tuberculous spondylodiscitis,” and “functional outcome” for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions.

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