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9. Selective estrogen receptor modulation prevents scoliotic curve progression: radiologic and histomorphometric study on a bipedal C57Bl6 mice model

Author

Demirkiran, Gokhan, Dede, Ozgur, Yalcin, Nadir, Akel, Ibrahim, Marcucio, Ralph, and Acaroglu, Emre

Subjects
Prevention, Animals, Bone Density, Disease Models, Animal, Disease Progression, Female, Mice, Mice, Inbred C57BL, Raloxifene Hydrochloride, Scoliosis, Selective Estrogen Receptor Modulators, Tamoxifen, Animal model, Bipedal mice, Bone density, Raloxifene, Biomedical Engineering, Clinical Sciences, Orthopedics
Abstract

PurposePrevious work has suggested that progression of experimental scoliotic curves in pinealectomized chicken and bipedal C57BL6 mice models may be prevented and reversed with Tamoxifen treatment. Raloxifene is another Selective Estrogen Receptor Modulator (SERM) with estrogen agonist effects on bone and increases bone density but with fewer side effects on humans. To investigate whether scoliosis progression in bipedal C57Bl6 mice model could be prevented with SERM treatment and the mechanisms associated with this effect.MethodsEighty C57BL6 mice were rendered bipedal and divided into Tamoxifen (TMX), Raloxifene (RLX) and control groups. TMX and RLX groups received orally administered TMX and RLX for 40 weeks. Anteroposterior X-ray imaging and histomorphometric analysis (at 20th and 40th weeks) were performed.ResultsAt 20th week, TMX and RLX groups displayed higher rates (p = 0.033, p = 0.029) and larger curve magnitudes (p = 0.018). At 40th week, curve rates were similar between the groups but the curve magnitudes in TMX and RLX groups were smaller (p = 0.001). Histomorphometry revealed that treated animals had higher trabecular density (p = 0.04), lower total intervertebral disc (p = 0.038) and growth plate volumes (p = 0.005) and smaller vertebral bodies (p = 0.016).ConclusionsTreatment with TMX or RLX did not reduce the incidence of scoliosis but decreased the curve magnitudes at 40 weeks. The underlying mechanism associated with the decrease in curve magnitudes may be the early maturation of growth plates, thereby possible deceleration of the growth rate of the vertebral column and increase in bone density. RLX is as effective as TMX in preventing the progression of scoliotic curves in melatonin deficient bipedal mice.

Published
2014

11. The Adult Deformity Surgery Complexity Index (ADSCI): a valid tool to quantify the complexity of posterior adult spinal deformity surgery and predict postoperative complications

Author

Pellisé, Ferran, Vila-Casademunt, Alba, Núñez-Pereira, Susana, Domingo-Sàbat, Montse, Bagó, Juan, Vidal, Xavier, Alanay, Ahmet, Acaroglu, Emre, Kleinstück, Frank, Obeid, Ibrahim, Pérez-Grueso, Francisco J.S., Lafage, Virginie, Bess, Shay, Ames, Christopher, and Mannion, Anne F.

Published
2018
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12. Adult spinal deformity surgical decision-making score: Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with adult spinal deformity

Author

Fujishiro, Takashi, Boissière, Louis, Cawley, Derek Thomas, Larrieu, Daniel, Gille, Olivier, Vital, Jean-Marc, Pellisé, Ferran, Pérez-Grueso, Francisco Javier Sanchez, Kleinstück, Frank, Acaroglu, Emre, Alanay, Ahmet, Obeid, Ibrahim, and European Spine Study Group, ESSG

Published
2019
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14. Is decreased bone mineral density associated with development of scoliosis?A bipedal osteopenic rat model

Author

Dede, Ozgur, Akel, Ibrahim, Demirkiran, Gokhan, Yalcin, Nadir, Marcucio, Ralph, and Acaroglu, Emre

Abstract

Abstract Background An association between adolescent idiopathic scoliosis and osteopenia has been proposed to exist. It is still not clear whether there is such an association and if so, whether osteopenia is a causative factor or a consequence. Our previous pilot studies have suggested the presence of osteopenia in scoliotic animals. The aim of this study was to investigate the development of scoliosis in an unpinealectomized bipedal osteopenic rat model, implementing osteoporosis as a causative factor. Methods Fifty Sprague-Dawley rats were rendered bipedal at the 3rd postnatal week and separated into control (25 rats) and heparin (25 rats receiving 1 IU/gr body weight/day) groups. DEXA scans after 4 weeks of heparin administration showed low bone mass in the heparin group. Anteroposterior and lateral x-rays of the surviving 42 animals (19 in heparin and 23 in control groups) were taken under anesthesia at the 40th week to evaluate for spinal deformity. Additional histomorphometric analysis was done on spine specimens to confirm the low bone mass in heparin receiving animals. Results of the DEXA scans, histomorphometric analysis and radiological data were compared between the groups. Results Bone mineral densities of rats in the heparin group were significantly lower than the control group as evidenced by both the DEXA scans and histomorphometric analyses. However, the incidence of scoliosis (82% in heparin and 65% in control; p > 0.05) as well as the curve magnitudes (12.1 ± 3.8 in heparin versus 10.1 ± 4.3 degrees in control; p > 0.05) were not significantly different. Osteopenic rats were significantly less kyphotic compared to control specimens (p = 0.001). Conclusions This study has revealed two important findings. One is that bipedality (in the absence of pinealectomy) by itself may be a cause of scoliosis in this animal model. Further studies on animal models need to consider bipedality as an independent factor. Secondly, relative hypokyphosis in osteopenic animals may have important implications. The absence of sagittal plane analyses in previous studies makes comparison impossible, but nonetheless these findings suggest that osteopenia may be important in the development of 3D deformity in adolescent idiopathic scoliosis.

Published
2011

15. Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO

Author

Pizones, Javier, Perez-Grueso, Francisco Javier Sánchez, Moreno-Manzanaro, Lucía, Vila-Casademunt, Alba, Boissiere, Louis, Yilgor, Caglar, Fernández-Baíllo, Nicomedes, Sánchez-Márquez, José Miguel, Talavera, Gloria, Kleinstück, Frank, Acaroglu, Emre R., Alanay, Ahmet, Pellisé, Ferran, and Obeid, Ibrahim

Abstract

Study design: Retrospective analysis of prospectively collected data. Objective: To determine the influence of postoperative ideal lordosis distribution and ideal sagittal harmony on mechanical complications in patients undergoing one-level lumbar pedicle subtraction osteotomy (L-PSO). Summary of background data: Many variables have been associated with mechanical complications after L-PSO. However, the impact of restoring the ideal inflexion point, lumbar apex, and sagittal shape is still underexplored. Methods: Analyzed risk factors were: age and patient-related variables, PSO level, interbody cages, rod material/diameter, number of rods, upper instrumented vertebra, lower instrumented vertebra, PI-LL mismatch, global tilt (GT), postoperative level of lumbar apex (LApex), postoperative level of inflexion point (InfxP), and postoperative type of Roussouly sagittal profile (R-type). These last variables were compared to ideal (based on pelvic incidence). Univariate and multivariate analyses were performed to identify risks for mechanical complications with a minimum 2-year follow-up. Results: A total of 87 patients were included. Mean follow-up was 4.5?±?1.7 years. 40.2% of the patients suffered postoperative mechanical complications (7 PJK, 4 PJF, 18 pseudoarthrosis/rod breakage, 6 screw pullout). Mean time for complications was 584?±?416 days from surgery. Univariate analysis showed that age (63 vs 57 years; P?=?0.04), BMI (28.1 vs 25.9; P?=?0.024), preoperative-GT (50.7° vs 38.7°; P?<?0.001), postoperative-GT (28.9° vs 23.4°; P?=?0.018), postoperative LApex location mismatched from ideal (77.8% vs 22.2%; P?=?0.036), and postoperative R-type mismatched from ideal (67.6% vs 22.6%; P?<?0.001) were significantly related to mechanical complications. The independent factors selected by multivariate analysis were: postoperative R-type mismatched from ideal OR 11.3 (95% CI? ?3.9–32.6; P?<?0.001), age OR 1.05 (95% CI 1–1.1; P?=?0.03), and LApex matching OR 0.5 (95% CI 0.27–0.97; P?=?0.04). The further the LApex was from its ideal position, the higher the risk of mechanical complications (P?=?0.036). Conclusions: Over other multiple suspected risk factors, proper lumbar apex position and ideal sagittal shape restoration played an important role in postoperative mechanical complications after L-PSO. Level of evidence: III.

Published
2024
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20. External validation of the adult spinal deformity (ASD) frailty index (ASD-FI)

Author

Miller, Emily K., Vila-Casademunt, Alba, Neuman, Brian J., Sciubba, Daniel M., Kebaish, Khaled M., Smith, Justin S., Alanay, Ahmet, Acaroglu, Emre R., Kleinstück, Frank, Obeid, Ibrahim, Sánchez Pérez-Grueso, Francisco Javier, Carreon, Leah Y., Schwab, Frank J., Bess, Shay, Scheer, Justin K., Lafage, Virginie, Shaffrey, Christopher I., Pellisé, Ferran, Ames, Christopher P., The European Spine Study Group, and The International Spine Study Group

Published
2018
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21. The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

Author

Nabi, Vugar, Ayhan, Selim, Yuksel, Selcen, Adhikari, Prashant, Vila-Casademunt, Alba, Pellise, Ferran, Perez-Grueso, Francisco Sanchez, Alanay, Ahmet, Obeid, Ibrahim, Kleinstueck, Frank, Acaroglu, Emre, Grp, European Spine Study, Acibadem University Dspace, Institut Català de la Salut, [Nabi V] Department of Orthopaedics and Traumatology, Antalya Research and Education Hospital, Ministry of Health, University of Health Science, Antalya, Turkey. [Ayhan S] Department of Neurosurgery, Baskent University Hospital, Ankara, Turkey. [Yuksel S] Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey. [Adhikari P] ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey. [Vila-Casademunt A, Pellise F] Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, Blood management, Anemia, Health-related quality of life, sistema musculoesquelético::esqueleto::huesos::columna vertebral [ANATOMÍA], Adult spine deformity, Scoliosis, Quality of life, Statistical significance, medicine, Columna vertebral - Malformacions - Cirurgia, Orthopedics and Sports Medicine, Patient outcome assessment, Hospitals - Ingressos i altes, Hospital readmission, business.industry, diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Otros calificadores::Otros calificadores::/cirugía [Otros calificadores], Retrospective cohort study, Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], medicine.disease, Other subheadings::Other subheadings::/surgery [Other subheadings], Surgery, Therapeutics::Patient Care::Hospitalization::Patient Readmission [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Avaluació de resultats (Assistència sanitària), terapéutica::asistencia al paciente::hospitalización::reingreso de pacientes [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Hemoglobin, business, Musculoskeletal System::Skeleton::Bone and Bones::Spine [ANATOMY]
Abstract

Adult spine deformity; Anemia; Patient outcome assessment Deformidad de la columna en adultos; Anemia; Evaluación del resultado del paciente Deformitat de la columna en adults; Anèmia; Avaluació dels resultats del pacient Study Design Retrospective cohort. Purpose This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of Literature Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. Conclusions The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery. European Spine Study Group is a clinical research group funded by a research grant from DePuy-Synthes.

Published
2022

30. Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine

Author

Kieser, David Christopher, Boissiere, Louis, Bourghli, Anouar, Hayashi, Kazunori, Cawley, Derek, Yilgor, Caglar, Alanay, Ahmet, Acaroglu, Emre, Kleinstueck, Frank, Pizones, Javier, Pellise, Ferran, Perez-Grueso, Francisco Javier Sanchez, Obeid, Ibrahim, Grp, European Spine Study, Institut Català de la Salut, [Kieser DC] Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand. [Boissiere L, Hayashi K, Cawley D] L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France. [Bourghli A] Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia. [Yilgor C] Acibadem University School of Medicine, Istanbul, Turkey. [Pellise F] Unitat de Cirurgia de Columna, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, and Acibadem University Dspace

Subjects
Pelvic tilt, medicine.medical_specialty, Multivariate analysis, deformity, Scoliosis, spine, Edat òssia, medicine, Deformity, Columna vertebral - Malformacions - Cirurgia, RC346-429, Epidemiology and Biostatistics::Epidemiology::Epidemiologic Studies::Epidemiology, Descriptive::Population Characteristics::Age Effect [PUBLIC HEALTH], Musculoskeletal Diseases::Bone Diseases::Bone Malalignment [DISEASES], scoliosis, enfermedades musculoesqueléticas::enfermedades óseas::desviación ósea [ENFERMEDADES], Cobb angle, business.industry, epidemiología y bioestadística::epidemiología::estudios epidemiológicos::epidemiología descriptiva::Características de la Población::efecto edad [SALUD PÚBLICA], Confounding, Otros calificadores::Otros calificadores::/cirugía [Otros calificadores], medicine.disease, Sagittal plane, Other subheadings::Other subheadings::/surgery [Other subheadings], Surgery, medicine.anatomical_structure, Coronal plane, Neurology (clinical), Neurology. Diseases of the nervous system, medicine.symptom, business, coronal malalignment
Abstract

Deformitat; Escoliosi; Columna vertebral Deformidad; Escoliosis; Espina dorsal Deformity; Scoliosis; Spine Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD

Published
2021

34. A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden?

Author

Acaroglu, Emre, Yavuz, Aysun Cetinyurek, Guler, Umit Ozgur, Yuksel, Selcen, Yavuz, Yasemin, Domingo-Sabat, Montse, Pellise, Ferran, Alanay, Ahmet, Perez Grueso, Francesco Sanchez, Kleinstück, Frank, Obeid, Ibrahim, and European Spine Study Group

Published
2016
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44. Evaluation of Blended Online Learning in Three Spinal Surgery Educational Courses

Author

Acaroglu, Emre, primary, Assous, Muhammed, additional, Bransford, Richard, additional, Dal Oglio Da Rocha, Luiz Gustavo, additional, Falavigna, Asdrubal, additional, France, John, additional, Viale, Emiliano, additional, Uz-Zaman, Atiq, additional, Aviles, Ginesa, additional, Amster, Brian, additional, Cunningham, Michael, additional, and Şenköylü, Alpaslan, additional

Published
2022
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