Two Surprising Keys to Cervical Alignment Correction
You must assess certain radiographic parameters, says new work from Singapore, in order to obtain patient-specific alignment correction. Those parameters? Sagittal vertical axis and T1-slope.
Their work, “Cervical Alignment Variations in Different Postures and Predictors of Normal Cervical Kyphosis: A New Understanding,” appears in the November 1, 2017 edition of Spine. Hwee Weng Dennis Hey, M.B.B.S. is a consultant in the Division of Spine Surgery at the University Orthopaedics, Hand and Reconstructive Microsurgery Cluster in National University Hospital in Singapore.
Dr. Hey commented to OTW, “Realignment surgeries of the spine are increasingly recognized as key to good patient reported outcomes after surgery. Understanding normal sagittal morphology of the spine is of paramount importance. This is a prospectively conducted study and gives the highest level of evidence.”
The authors wrote, “Standing, erect sitting, and natural sitting whole-spine radiographs were obtained from 26 consecutive patients without cervical spine pathology…Most patients (73%) do not have lordotic cervical alignment (C2-C7) upon standing. Lordosis increases significantly when transitioning from standing to erect sitting, as well as from erect to natural sitting. Transition from standing to natural sitting also produces concomitant increases in SVA [sagittal vertical axis] and T1-slope.”
Dr. Hey told OTW, “Sagittal alignment of the cervical spine, conventionally thought to be lordotic, is in fact not always true. Several radiographic predictors can be identified to determine if kyphosis exists. Realignment surgeries of the cervical spine must consider these radiographic parameters (SVA and T1-slope) to achieve a patient-specific alignment correction. Routine assessment of these radiographic parameters (SVA and T1-slope) is necessary for surgical planning, so as to ensure best outcomes for patients.”
New Fracture Prevention Target: Air Pollution
Pairing clinical bone mineral density (BMD) and Medicare data on hospital admissions for bone fractures has resulted in novel research indicating that air pollution is a risk factor for bone mineral loss and osteoporotic fractures.
“Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies,” was published in the November 2017 edition of The Lancet Planetary Health.
Co-author Andrea A. Baccarelli, Ph.D., with the Department of Environmental Health at the Harvard TH Chan School of Public Health told OTW, “These results are about a very important health issue, i.e., bone health. In the U.S., about 2.1 million osteoporosis-related bone fractures are reported each year, resulting in as much as US$20.3 billion in annual direct health costs. Not only that, but within one year of a bone fracture, the risk of death for older individuals increase by 10–20% with only 40% regaining full pre-fracture independence.”
“When I started to study air pollution ten years ago all we knew was that it affected the lungs and the cardiovascular system. Now we are realizing there is much more to it. This is the first time a study shows that it affects our bone health as well. Also, I am very proud to have brought this study to completion as it combines two coordinated studies (one based on data records and one on which individuals have been followed up over time). Therefore, it provides robust evidence from two different but complementary approaches.”
“We had this idea of getting two studies paired together rather than just one as usual. We had a clinical study following up individuals over time by looking at their bone mineral density in relation to how polluted is the area they live. Then, we got data from Medicare to look at hospital admissions for bone fractures. We thought the combination of the two approaches would be powerful.”
“Air pollution is a new risk factor for bone mineral loss and osteoporotic fractures. To my knowledge this is the first study of this type. One previous study in Sweden showed that individuals living in the countryside had a lower risk of osteoporosis. But that could have been attributed to many other differences between city and country living. This study is the first to identify air pollution as the culprit.”
“Air pollution is an important issue for your bone health. Be aware of it; it is also a huge issue for your lungs, your heart and your brain (this is well known from previous studies). Help reduce air pollution with your lifestyle. Avoid adding to it with your footprint. Walk, bike, take public transportation, avoid driving; if you drive and need a new car, and consider an electric or hybrid car, which will help your save also on your budget. As electricity is often made with coal burning, save on your energy footprint as well at home and at work. Use the energy you need, give up what you do not need.”
“It is important to know that in addition to smoking, early menopause, low physical activity and other well-known risk factors, there is a newly emerging risk factor such as air pollution. Air pollution is generally a mild risk factor so it might not be as important at the individual level. For instance, it is a much more moderate risk factor than first-hand smoking (btw: putting smoke into your lungs is not a great idea). Nonetheless, the reason why air pollution is an important concern is that everyone is exposed to it at some level. Therefore the number of diseases caused by air pollution is huge compared to the intensity of the threat.”
“The World Health Organization estimated that every year ambient air pollution causes three million premature death worldwide. Importantly, in 2014, 92% of the world population was living in places where the air quality guidelines set by the World Health Organization were not met. Please note that the longitudinal follow up in our study was done in the Boston area and the vast majority of people in the study were exposed to levels well below the current WHO and EPA [Environmental Protection Agency] standards. Also in the hospital admission analysis, most people were at levels below the standards. There is lots of concern about populations living in countries where the standards are generally not met.”
“Make responsible choices and help others make similar choices. Let your representatives know that you care about it and you want them to act at the national level to make your air as clean as possible.”
J&J Unveils “Engineering Studio” at Texas Medical Center
Down in Texas they are pushing the innovation envelope these days.
Johnson & Johnson Medical Devices Companies (JJMDC) has opened the Center for Device Innovation (CDI) at the Texas Medical Center (TMC). The initiative, a collaboration between Johnson & Johnson Innovation LLC and Texas Medical Center, is part of a 26,000 square foot facility meant to accelerate the development of medical devices.
According to a November 9, 2017 news release, “Housed within the TMC Innovation Institute, the 26,000-square-foot facility will host JJMDC R&D staff working on select internal projects along with strategically aligned external ventures of JJMDC.”
“For the first time, medical devices innovators will be able to execute each stage of the product development life cycle without ever having to leave TMC, enabling unparalleled efficiency in responding to patient needs. The TMC Innovation Institute is also home to JLABS @ TMC, a life sciences incubator and TMC’s first collaboration with JJI, which opened in 2016.”
“CDI @ TMC represents unprecedented collaboration between the scientists, business leaders, academicians and investors required to bring revolutionary medical devices from concept to market,” said Sandi Peterson, group worldwide chair of Johnson & Johnson. “With all these resources in one zip code, medical devices may be developed, tested, moved to clinical trials and regulatory approval, then provided to the doctors and patients around the world who need them faster than ever before.”
William E. “Billy” Cohn, M.D., vice president, JJMDC and director of CDI @ TMC, told OTW, “Over the last 20 or so years, I have enjoyed innovating and prototyping medical devices in my garage…during evenings and weekends, while working as a busy academic heart surgeon. I have been fortunate to have invented several medical devices that have achieved commercial success. The Center for Device Innovation allows me to ramp up my innovative efforts and to work with like-minded individuals in the ultimate maker space. We intend to keep the startup mania, while leveraging the incredible resources of Johnson & Johnson, the largest healthcare company in the world, and the Texas Medical Center.”
“We are currently reviewing five projects. The biggest challenge for me has been narrowing down what we want to work on and selecting our staff from the large number of people eager to work in our new facility!”
“By one year, we hope to have generated clear evidence that the projects we are working on are as impactful as we think they will be. By one year, we hope to have robust prototypes and compelling preclinical evidence that the technologies we have chosen to work on are indeed disruptive and exciting to the doctors that will use them. If the projects aren’t as exciting as we hope, by one year we will have hopefully kicked them to the curb, and pivoted to projects that are more likely to succeed.”
“If you have an idea for an orthopedic project, come see us, and let’s work together to prototype your device and perform early experiments. After a few iterations and a little evolution of the idea, perhaps together we can compel the leaders at DePuy Synthes that the technology is worth dedicating additional resources to. Together we can create the next transformative orthopedic technology.”
