Surgical versus non-surgical treatment for lumbar spinal stenosis

Cochrane: We reviewed the evidence that compares surgery versus non-surgical treatment for a condition called lumbar spinal stenosis. This condition occurs when the area surrounding the spinal cord and nerves becomes smaller.
People with lumbar spinal stenosis experience a range of symptoms including back pain, leg pain, numbness and tingling in the legs and reduced physical function. These symptoms prompt people to seek treatment. One option for treatment is surgery. Other treatment options include physical therapy, exercise, braces and injections into the spine.

Knee surgery 'waste of time', researchers argue

NHS: "Knee surgery is 'pointless and potentially harmful' for thousands of patients,” the Daily Mirror reports.
Researchers have looked at previous studies that had compared arthroscopic (keyhole) knee surgery with exercise or sham surgery (placebo) for middle-aged people with knee pain – specifically, knee pain caused by osteoarthritis or a tear in the cartilage, but not those with a ligament condition. They found that both exercise and arthroscopy improved knee pain. Arthroscopy was slightly better, improving pain by a small amount, which was described as the equivalent to using a painkiller such as paracetamol or ibuprofen. There was no difference between the interventions for function of the knee.

Knee surgery on middle aged or older patients is only marginally beneficial

Scimex: A Danish and Swedish study has found knee surgery performed on middle aged or older patients is only marginally beneficial, and could even cause harm. The study brought together 18 trials of knee surgery, and the researchers say the potential harms identified, which include deep vein thrombosis and blocked arteries, outweigh the small benefits seen in terms of pain relief in some studies.

Application of 3D printing in orthopedics

Annals of Translational Medicine: The 3D printing technology is penetrating the healthcare field at an astonishing rate. Although there is still a long way to go to realize organ printing and despite the constantly existing ethical and technical changes (1), the 3D printing can form 3D supporting structures in a controllable manner and has shown charms in fields such as tissue engineering and regenerative medicine along with the advances in cell printing and bio-printing and the innovation of printing materials (2-4). In the clinical settings, 3D printing, as a novel additive manufacturing technique, is mainly applied in orthopedics and stomatology (5). A group of 3D printing-based patient-specific osteotomy instruments, orthopedic implants, and dental implants have been licensed by the US Food and Drug Administration (FDA) and Caritas Europa (CE) for clinical use.

Cannes tries to bring women to heel – but high shoes are a menace to the body

TheConversation: Cannes festival organisers recently sparked controversy after a group of women, some of whom had medical conditions, was reportedly turned away from a gala screening for failing to wear high-heeled shoes. While it is unclear what the fashion police had the most problem with, the lack of heels or the idea of flat shoes with rhinestones, the incident does raise some important questions about wearing footwear that isn’t very good for you. Wearing high shoes regularly and for long periods of time can change the way you walk and lead to long-term bone and joint problems. Not to mention the usual problems that come with corns and bunions that come with toes rubbing or being pushed into particular positions (“hammertoe” anyone?).

New technology shows potential in repairing damaged tissue in knee joints

Liverpool: A company, founded by University of Liverpool scientist, Professor Anthony Hollander, has been awarded £2 million to develop stem cell technologies that have shown potential in repairing damaged tissue in the knee. The team at Liverpool, in partnership with NHS Blood and Transplant, is part of a £6.3 million funding initiative, supported by Innovate UK and Cell Therapy Catapult, to help further technological development in stem cell therapies in the UK.  Professor Hollander and colleagues launched the company, Azellon, to produce stem cell therapies for treatment of damaged fibrous tissues in the knee, called meniscal cartilage. Using Cell Bandage technology, the team has shown encouraging test results from combining bone marrow stem cells with a special membrane that helps deliver cells to the injured site.

New technology shows potential in repairing damaged tissue in knee joints

Liverpool: A company is developping stem cell technologies that have shown potential in repairing damaged tissue in the knee. Professor Hollander and colleagues launched the company, Azellon, to produce stem cell therapies for treatment of damaged fibrous tissues in the knee, called meniscal cartilage. Using Cell Bandage technology, the team has shown encouraging test results from combining bone marrow stem cells with a special membrane that helps deliver cells to the injured site.

No Difference for Surgical vs Non-Surgical Treatment of Displaced Fracture of Upper Arm

JAMA: Among patients with a displaced fracture in the upper arm near the shoulder (proximal humeral), there was no significant difference between surgical treatment and nonsurgical treatment in patient-reported outcomes over two years following the fracture, results that do not support the trend of increased surgery for patients with this type of fracture, according to a study in the March 10 issue of JAMA.

In case of a cruciate ligament rupture, the load-bearing capacity of the cruciate ligament replacement can be precisely evaluated using a new imaging process

Vienna University. Austria: A footballer is able to play football again or to recommence training six months after an operation on a cruciate ligament rupture in case of a normal healing process. This interruption is common in professional football, but it is merely an empirical value, as Siegfried Trattnig from the University Clinic for Radiology and Nuclear Medicine at the MedUni Wien (Medical University of Vienna) has emphasised. In future, however, it will be possible to evaluate precisely both the load-bearing capacity of the "new" cruciate ligament and the risk of a renewed rupture using a new imaging process methodologically developed for clinical use at the MedUni Wien, with which the biomechanical properties of the knee and the cruciate ligament can be measured. 

Surgical versus non-surgical treatment after kneecap dislocation

Cochrane: The patella or kneecap is a lens-shaped bone situated at the front of the knee. It is incorporated into the tendon of the quadriceps muscles of the thigh and moves within a groove at the lower end of the thigh bone (femur). Patellar dislocation occurs when the patella completely moves out of this groove. It typically occurs in young and physically active people with minimal trauma when they twist the bent knee with the foot fixed to the ground, for example, during sporting activities.

Launch of World First Bone Repair Technology Marks Successful First Year for Amber

RCSI. Ireland: AMBER, the Science Foundation Ireland (SFI) funded materials science centre, hosted in Trinity College Dublin, has today unveiled a new bone repair technology, which has led to an injured racehorse returning to winning ways after successful jaw reconstruction.  The announcement was made at AMBER’s Industry Day, held to mark its first anniversary, which was officially opened by Minister for Skills, Research and Innovation Damien English T.D. and which brought together a number of AMBER’s industry partners.

Both weight loss and weight gain linked with increased fracture risk

BMJ. UK: Both weight gain and weight loss in older (postmenopausal) women are associated with increased incidence of fracture, but at different anatomical sites, finds a study published in The BMJ this week.
The findings also challenge the traditional view that weight gain protects against fractures.

Bone Regeneration Enhanced by Use of Mussel Adhesive Proteins

Postech University. Korea: Mussels stick to rocks because its protein has strong adhesive properties. This protein has been used as a binder for bodily wounds and surgery. An engineered mussel glue protein, a promising functional binder for the acceleration of bone substitute-assisted bone regeneration, has been developed by the joint research team of POSTECH and Korea University Anam Hospital, which can be used in teeth implants.

Exercise therapy for adolescents and adults with pain behind or around the kneecap

Cochrane: Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain. It is often referred to as anterior knee pain. The pain mostly occurs when load is put on the muscles that extend the leg when climbing stairs, squatting, running, cycling or sitting with bent knees. Exercise therapy is often prescribed for this condition.

A First in Quebec in the Field of Scoliosis

Montreal University. Canada: The Sainte-Justine University Hospital Center (CHU Sainte-Justine) affiliated to Université de Montréal is now the first institution in Québec, the second in Canada and among the world's top ten to perform a revolutionary back surgery technique in children with scoliosis. The number of such surgeries performed worldwide so far is less than a hundred.

Spine surgery patient gets fast relief after years of severe neck pain

Loyola University. US: After suffering years of severe neck pain, Debbie Yuss, RN, decided to see Loyola University Medical Center spine surgeon Alexander Ghanayem, MD.
As a worker’s compensation case manager, Ms. Yuss had seen firsthand the results Dr. Ghanayem achieves in treating spinal problems.
“I knew just how good he is,” she said.
Dr. Ghanayem performed a two-level spinal fusion at the base of Ms. Yuss’ neck. “I went home the next morning, and felt absolutely great,” she said.

Spinal fusion

Mayo Clinic. US: Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.
Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit.
Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate.

Spinal stenosis

Spinal stenosis is defined as narrowing of the spinal canal (the canal in the center of the spine), lateral recess (the narrowing of the tunnels where the nerve roots exit the central spinal canal), or intervertebral foramina (holes in the vertebrae which nerve roots exit). It can occur at any age and is typically due to the degeneration and enlargement of the facet joints (small joints between upper and lower vertebrae), the protrusion or herniation of the intervertebral discs and/or ligamentum flavum hypertrophy (a strong ligament that connects the vertebrae together). The narrowing of the canals puts pressure on the neural elements of the spine, including the spinal cord and nerve roots. Pressure on the upper part of the spine (neck area) usually produces pain, numbness, tingling or weakness in the shoulders, or arms. Pressure on the lower part of the spine (low back area) usually causes similar symptoms in the legs.
More about spinal stenosis

Sciatica

Sciatica is a buttock pain radiating down the back of the thigh and leg and possibly into the calf or foot.  Other characteristics of sciatica include varying degrees of weakness in the leg muscles and numbness and/or tingling that radiates down the leg.  These symptoms occur because of compression and/or irritation of the sciatic nerve or nerve roots which are forming the sciatic nerve. The areas in the buttock and leg affected by this compression are the areas that the sciatic nerve supplies with messages for normal function.  There are many other names for sciatica including lumbosacral radicular syndrome, radiating low back pain, nerve root pain, and nerve root entrapment.
More about sciatica

Scoliosis

• Scoliosis is defined as a lateral curvature of the spine in the frontal plane of the body, which means that the vertebral column bends from side-to-side. 
• The most common form of scoliosis (over 85% of cases) is called "idiopathic scoliosis.” This simply means that the cause is not known. Scoliosis curves of greater than 10° affect 0.5-3% of the population of the United States. 
• Symptoms:
  Pediatric scoliosis is usually painless. Often the curvature itself may be too subtle to even be noticed. Parents may notice abnormal posture in their growing child and the major complaint is usually a clinically apparent deformity.
  Most symptoms are associated with the spine being curved.
  Symptoms of scoliosis can include:
  · Leaning more to one side than the other
  · A rib "hump" and/or a protruding shoulder blade
  · The opposite sides of the body may not appear level
  · A tilted head that does not line up over the hips
  · One hip or shoulder that is higher than the other, causing an uneven waist
  · In developing girls, breasts appearing to be of unequal size
  · Unequal distance between arms and body
  · Clothes that do not "hang right," i.e., uneven hemlines
  · Walking with a rolling gait
• Diagnosis can include: An inclinometer (Scoliometer) measures distortions of the torso. Physical examination Radiographic evaluation (standing full-length spine posterior-anterior and lateral x-ray film). 
• The three basic treatment options for AIS include: Observation, non-operative treatment and surgery. -OBSERVATION si the treatment of choice when the curvature of the spine is minimal, somewhere between 20 and 30 degrees.
  -NON-OPERATIVE TREATMENT includes bracing to prevent curves from progressing, not to correct scoliosis itself, exercise that has many health benefits and is important for maintaining strength and muscle tone and stabilizing weight.
  -SURGERY : Spinal fusion, also known as spondylodesis or spondylosyndesis is the most widely performed surgery for correction of scoliosis. 
• More about scoliosis