2.Prevalence, Patterns, and Genetic Association Analysis of Modic Vertebral Endplate Changes.
Rishi Mugesh KANNA ; Rajasekaran SHANMUGANATHAN ; Veera Ranjani RAJAGOPALAN ; Senthil NATESAN ; Raveendran MUTHURAJA ; Kenneth Man Chee CHEUNG ; Danny CHAN ; Patrick Yu Ping KAO ; Anita YEE ; Ajoy Prasad SHETTY
Asian Spine Journal 2017;11(4):594-600
STUDY DESIGN: A prospective genetic association study. PURPOSE: The etiology of Modic changes (MCs) is unclear. Recently, the role of genetic factors in the etiology of MCs has been evaluated. However, studies with a larger patient subset are lacking, and candidate genes involved in other disc degeneration phenotypes have not been evaluated. We studied the prevalence of MCs and genetic association of 41 candidate genes in a large Indian cohort. OVERVIEW OF LITERATURE: MCs are vertebral endplate signal changes predominantly observed in the lumbar spine. A significant association between MCs and lumbar disc degeneration and nonspecific low back pain has been described, with the etiopathogenesis implicating various mechanical, infective, and biochemical factors. METHODS: We studied 809 patients using 1.5-T magnetic resonance imaging to determine the prevalence, patterns, distribution, and type of lumbar MCs. Genetic association analysis of 71 single nucleotide polymorphisms (SNPs) of 41 candidate genes was performed based on the presence or absence of MCs. SNPs were genotyped using the Sequenome platform, and an association test was performed using PLINK software. RESULTS: The mean age of the study population (n=809) was 36.7±10.8 years. Based on the presence of MCs, the cohort was divided into 702 controls and 107 cases (prevalence, 13%). MCs were more commonly present in the lower (149/251, 59.4%) than in the upper (102/251, 40.6%) endplates. L4–5 endplates were the most commonly affected levels (30.7%). Type 2 MCs were the most commonly observed pattern (n=206, 82%). The rs2228570 SNP of VDR (p=0.02) and rs17099008 SNP of MMP20 (p=0.03) were significantly associated with MCs. CONCLUSIONS: Genetic polymorphisms of SNPs of VDR and MMP20 were significantly associated with MCs. Understanding the etiopathogenetic mechanisms of MCs is important for planning preventive and therapeutic strategies.
Cohort Studies
;
Genetic Association Studies
;
Humans
;
Intervertebral Disc Degeneration
;
Low Back Pain
;
Magnetic Resonance Imaging
;
Phenotype
;
Polymorphism, Genetic
;
Polymorphism, Single Nucleotide
;
Prevalence*
;
Prospective Studies
;
Spine
3.Functional Outcome of Open Latarjet Procedure in NonAthletic Middle-Aged Patie
Joshi S ; Rao VKV ; Shetty UC ; Rai S ; Arora S ; Kumar SR
Malaysian Orthopaedic Journal 2021;15(No.2):151-158
Introduction: The movement and steadiness of the shoulder
joint is due to both the dynamic and static stabilisers.
Recurrent anterior shoulder instability is common due to the
Bankart lesion or the Hill Sachs lesion. The bone loss and
soft tissue failure due to these lesions causing instability is
well compensated by Latarjet procedure which acts by triple
blocking effect of the bone graft, the sling effect of the
conjoint tendon of subscapularis and the ligament of the
coracoacromial ligament stump.
Materials and methods: Middle-aged patients with
recurrent anterior shoulder dislocation and a mid-range
instability on clinical assessment with an isolated glenoid
bone loss of 20% or Bankart lesion with engaging Hill Sachs
lesion were selected for the study. The surgical procedure
included a subscapularis split to expose the glenoid. The
coracoid graft harvested was prefixed with Kirschner wires
and placed flush over the glenoid ensuring no medial or
lateral overhang and fixed with 4.0mm cancellous screws
with the washer. The functional outcome was measured with
the ROWE score and ASES score and the movements were
evaluated.
Results: A total of 24 patients fulfilled the inclusion criteria.
Post-operatively at final follow-up, the mean ROWE score
was 97.08 ±8.45 and the mean ASES score was 94.4±9.10.
One patient had screw breakage as a complication and
another had restriction of movement which was managed
with physiotherapy.
Conclusion: Open Latarjet is an effective procedure for
recurrent anterior shoulder instability in non-athletic middleaged patients as a excellent functional outcome was achieved
with this technique. We therefore recommend open Latarjet
as an alternative to arthroscopic treatment in developing
countries where patient affordability and the availability of
the resources are the issues.