Does Sarcopenia Increase the Risk for Fresh Vertebral Fragility Fractures?: A Case-Control Study

Ashish Anand,Ajoy Prasad Shetty,K. R. Renjith,Sri Vijay Anand K. S.,Rishi Mugesh Kanna,Shanmuganathan Rajasekaran 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.1

Study Design: Case-control study. Purpose: Sarcopenia is an age associated condition characterized by decrease in muscle mass, strength, and physical performance. We aimed to investigate whether sarcopenia increased the risk of vertebral fragility fractures among the elderly. Overview of Literature: Initial reports on sarcopenia suggest its contribution to the development of vertebral fragility fractures. However, recent studies showed contradictory findings. Methods: Fifty-one consecutive patients with vertebral fragility fractures and matched controls without fractures were evaluated for sarcopenia, T-score, body mass index, and presence of preexisting vertebral fractures. Sarcopenia was diagnosed as total psoas cross-sectional area (TPA) 2 standard deviations below normative value from normal young adults and decreased handgrip strength (26 kg for men and 18 kg for women). Univariate and multivariate analyses were performed using the fresh fracture occurrence as the dependent variable. Results: Sarcopenia was confirmed in 29.4% and 7.8% of cases and controls (p=0.005), respectively; 56.8% and 13.7% of cases and controls had previous vertebral fractures. Sarcopenia prevalence was greater among those with previous fractures (38% vs. 7.6%; odds ratio, 7.76; p<0.001). TPA was lower among the cases (1,278 mm2 vs. 1,569 mm2, p=0.001) and those with previous fractures (1,168 mm2 vs. 1,563 mm2, p<0.001). Handgrip strength was greater among those without previous fractures (19.6 kg vs. 16.3 kg, p=0.05). In multivariate analysis, sarcopenia was not identified as a significant predictor of fresh fractures whereas previous fractures and lower T-score were found to be significant. Conclusions: Sarcopenia is not an independent risk factor for fresh vertebral fragility fractures in the elderly.

Proteomic Signature of Nucleus Pulposus in Fetal Intervertebral Disc

Rajasekaran Shanmuganathan,Soundararajan Dilip Chand Raja,Tangavel Chitraa,K.S. Sri Vijay Anand,Nayagam Sharon Miracle,Matchado Monica Steffi,Muthurajan Raveendran,Shetty Ajoy Prasad,Kanna Rishi Muges 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: Profiling proteins expressed in the nucleus pulposus of fetal intervertebral disc (IVD).Purpose: To evaluate the molecular complexity of fetal IVDs not exposed to mechanical, traumatic, inflammatory, or infective insults to generate improved knowledge on disc homeostasis.Overview of Literature: Low back pain is the most common musculoskeletal disorder, causing a significant reduction in the quality of life, and degenerative disc disorders mainly contribute to the increasing socioeconomic burden. Despite extensive research, the causative pathomechanisms behind degenerative disc disorders are poorly understood. Precise molecular studies on the intricate biological processes involved in maintaining normal disc homeostasis are needed.Methods: IVDs of nine fetal specimens obtained from medical abortions were used to dissect out the annulus fibrosus and nucleus pulposus under sterile operating conditions. Dissected tissues were transferred to sterile Cryovials and snap frozen in liquid nitrogen before transporting to the research laboratory for protein extraction and further liquid chromatography tandem mass spectrometry (LC-MS/ MS) analysis. Collected data were further analyzed using Gene Functional Classification Tool in DAVID and STRING databases.Results: A total of 1,316 proteins were identified through LC-MS/MS analysis of nine fetal IVD tissues. Approximately 247 proteins present in at least four fetal discs were subjected to further bioinformatic analysis. The following 10 clusters of proteins were identified: collagens, ribosomal proteins, small leucine-rich proteins, matrilin and thrombospondin, annexins, protein disulfide isomerase family proteins and peroxiredoxins, tubulins, histones, hemoglobin, and prolyl 4-hydroxylase family proteins.Conclusions: This study provides fundamental information on the proteome networks involved in the growth and development of healthy fetal discs in humans. Systematic cataloging of proteins involved in various structural and regulatory processes has been performed. Proteins expressed most abundantly (collagen type XIV alpha 1 chain, biglycan, matrilin 1, and thrombospondin 1) in their respective clusters also elucidate the possibility of utilizing these proteins for potential regenerative therapies.

Posterior Stabilization of Unstable Sacral Fractures: A Single-Center Experience of Percutaneous Sacroiliac Screw and Lumbopelvic Fixation in 67 Cases

Shetty Ajoy Prasad,Renjith Karukayil Ramakrishnan,Perumal Ramesh,Anand Sri Vijay,Kanna Rishi Mugesh,Rajasekaran Shanmuganathan 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

Study Design: This is a retrospective study. Purpose: Recent advances in intraoperative imaging and closed reduction techniques have led to a shifting trend toward surgical management in every unstable sacral fracture. This study aimed to evaluate the clinicoradiological outcome of the sacroiliac (SI) screw and lumbopelvic fixation (LPF) techniques and thereby delineate the indications for each. Overview of Literature: Optimal management guidelines for unstable sacral fractures are still lacking probably due to the rarity of these injuries and varying fixation trends. Methods: Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon’s four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed’s functional grading system and Matta’s radiological criteria. The minimum follow-up period was 2 years. Results: Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved. Conclusions: Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.

Impact of Patient Counseling and Socioeconomic Factors on Initiation of Rehabilitation Program in Spinal Cord Injury Patients Presenting to a Tertiary Spine Unit in India

Kim Kyongsong,Siddharth Narasimhan Aiyer,Vignesh Gunasekaran,Latha Mani,Sri Vijay Anand K. S.,Shanmuganathan Rajasekaran,Ajoy Prasad Shetty 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.3

Study Design: Prospective case series. Purpose: This study aimed to investigate the impact of education, financial income, occupation, and patient counseling on the timing of enrolment in a spinal cord injury (SCI) rehabilitation program. Overview of Literature: A rehabilitation program following SCI is essential to improve functional outcomes. Socioeconomic factors can affect the timing of enrolment to a rehabilitation program. Literature on the effects of socioeconomic factors among patients with SCI in the Indian scenario is limited. Methods: A prospective, consecutive analysis of patients with SCI was performed with 1-year follow-up. Assessment of the timing of enrolment to a rehabilitation program was performed using the modified Kuppuswamy socioeconomic scores (MKSS). Patients admitted to the SCI unit (group A), underwent intensive individual, group, and family counseling sessions to encourage early enrolment into a rehabilitation program. Patients presenting directly for rehabilitation (group B) were analyzed for comparison. Results: A total of 153 patients were recruited. Group A was composed of 122 patients who started the rehabilitation program after a mean of 28 days, compared with a mean of 149 days for 31 patients in group B. In group A, 104 patients (85%; mean MKSS, 14.02) and 18 patients (15%; mean MKSS, 15.61) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. In group B, 12 patients (39%; mean MKSS, 13.69) and 19 patients (61%; mean MKSS, 12.10) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. The total MKSS and scores for education, income, and occupation did not show a significant difference between the two both groups (p>0.05). Conclusions: Early patient counseling in the acute care unit helps in the early enrolment of patients with poor socioeconomic demographic profile to a rehabilitation program.

Proteomic Signatures of Healthy Intervertebral Discs From Organ Donors: A Comparison With Previous Studies on Discs From Scoliosis, Animals, and Trauma

Shanmuganathan Rajasekaran,Chitraa Tangavel,Dilip Chand Raja Soundararajan,Sharon Miracle Nayagam,Monica Steffi Matchado,Raveendran Muthurajan,K.S. Sri Vijay Anand,Sunmathi Rajendran,Ajoy Prasad Shett 대한척추신경외과학회 2020 Neurospine Vol.17 No.2

Objective: To catalog and characterize the proteome of normal human intervertebral disc (IVD). Methods: Nine magnetic resonance imaging (MRI) normal IVDs were harvested from 9 different brain dead yet alive voluntary organ donors and were subjected to electrospray ionization-liquid chromatography tandem mass spectrometry (ESI-LC-MS/MS) acquisition. Results: A total of 1,116 proteins were identified. Functional enrichment analysis tool DAVID ver. 6.8 categorized: extracellular proteins (38%), intracellular (31%), protein-containing complex (13%), organelle (9%), membrane proteins (6%), supramolecular complex (2%), and 1% in the cell junction. Molecular function revealed: binding activity (42%), catalytic activity (31%), regulatory activity (14%), and structural activity (7%). Molecular transducer, transporter, and transcription regulator activity together contributed to 6%. A comparison of the proteins obtained from this study to others in the literature showed a wide variation in content with only 3% of bovine, 5% of murine, 54% of human scoliotic discs, and 10.2% of discs adjacent to lumbar burst fractures common to our study of organ donors. Between proteins reported in scoliosis and lumbar fracture patients, only 13.51% were common, further signifying the contrast amongst the various MRI normal IVD samples. Conclusion: The proteome of “healthy” human IVDs has been defined, and our results show that proteomic data on IVDs obtained from scoliosis, fracture patients, and cadavers lack normal physiological conditions and should not be used as biological controls despite normal MRI findings. This questions the validity of previous studies that have used such discs as controls for analyzing the pathomechanisms of disc degeneration.