Baastrup's disease: The kissing spine

A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.

Treatment of condylar osteophyte in temporomandibular joint osteoarthritis with muscle balance occlusal splint and long-term follow-up:A case report

BACKGROUND Condylar osteophytes,a remodeling form of temporomandibular joint osteoarthritis(TMJ OA),mainly manifest as marginal angular outgrowths of the condyle.Previous researchers have advocated surgical removal of condylar osteophytes.Reports on the effect of occlusal splint on TMJ OA patients’joints have mostly focused on treatment with this splint,which can reduce the absorption of the affected condyle and promote repair and regeneration.However,the effect of the splint on the dissolution of condylar osteophytes has not yet been reported.CASE SUMMARY A 68-year-old female patient suffered from occlusal discomfort with left facial pain for 2 years.Cone beam computed tomography showed a rare osteophyte on top of her left condyle.She was finally diagnosed with TMJ OA.The patient refused surgical treatment and received conservative treatment with a muscle balance occlusal splint.The pain experienced by the patient on the left side of her face was relieved,and her chewing ability recovered after treatment.The osteophyte dissolved,and the condylar cortex remained stable during long-term follow-up observations.CONCLUSION The muscle balance occlusal splint could be a noninvasive means of treating condylar osteophytes in TMJ OA patients.

Obturator nerve impingement caused by an osteophyte in the sacroiliac joint:A case report

BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.

Dysphagia in a patient with ankylosing spondylitis:A case report

BACKGROUND Ankylosing spondylitis(AS)is a systematic and rheumatic disease,which causes multiple symptoms.However,dysphagia due to the formation of a giant anterior cervical osteophyte is rare in patients with AS.CASE SUMMARY We present the case of a 65-year-old male patient who was diagnosed with AS and visited the hospital with a complaint of progressive dysphagia.The appropriate imaging examinations indicated that a giant anterior cervical osteophyte at C3-4 caused esophageal compression,which led to dysphagia.An operation for resection was performed without complications.CONCLUSION This case demonstrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS,and early accurate diagnosis and surgical treatment are very important for the improvement of symptoms.Anterior cervical discectomy and fusion are extremely effective and should be taken into consideration.

CT Scan of the Foot in Patients with Chronic Non-Healing Diabetic Foot Ulcer

Background: Diabetes mellitus is a chronic disease where there is an increased blood sugar level in the body which is either caused due to inability of the pancreas to secrete insulin or the body’s inability to utilize it. The prevalence of diabetes mellitus is growing rapidly worldwide. Statistics show that in the year 2014, there were a total of 422 million cases of DM. Diabetes mellitus is a major cause of heart attacks, kidney failure, blindness and leg amputations. Diabetic foot ulcers are quite common and are estimated to affect nearly 15% of all diabetic patients during their lifetime. In long standing diabetic patients with chronic non-healing ulcers, bony changes or deformities are not uncommon. These bony changes can be identified using CT scans. Materials and Methods: An observational study was conducted on a total of 40 patients with chronic non-healing ulcer attending the surgery outpatient department of Saveetha Medical College, Chennai, Tamilnadu. The CT-scans of their foot were observed for deformities or bony changes. Results: Out of 40 patients, 67.5% were males and 32.5% were females. A maximum number of subjects fell under the age group of 51 - 60 years. The most common site of the ulcer was found to be in the plantar surface of big toe (53%). Among the 40 patients, 33 of them were found to have bony abnormalities on the CT scan of foot and no apparent changes were seen in the rest. Bone erosions (35%), osteopenic changes (22.5%), Charcot’s joint (2.5%), osteophyte formation (12.5) and reduced joint space (10%) were the predominant changes observed on the CT scans of the study population.

Combination of magnesium ions and vitamin C alleviates synovitis and osteophyte formation in osteoarthritis of mice

Introduction:We previously demonstrated that magnesium ions(Mg^(2+))was a novel therapeutic alternative for osteoarthritis(OA)through promoting the hypoxia inducible factor-1α(HIF-1α)-mediated cartilage matrix synthesis.However,oxidative stress can inhibit the expression of HIF-1α,amplify the inflammation that potentially impairs the therapeutic efficacy of Mg^(2+) in OA.Vitamin(VC),a potent antioxidant,may enhance the efficacy of Mg^(2+) in OA treatment.This study aims to investigate the efficacy of combination of Mg^(2+)and VC on alleviating joint destruction and pain in OA.Material and methods:Anterior cruciate ligament transection with partial medial meniscectomy induced mice OA model were randomly received intra-articular injection of either saline,MgCl2(0.5 mol/L),VC(3 mg/ml)or MgCl2(0.5 mol/L)plus VC(3 mg/ml)at week 2 post-operation,twice weekly,for 2 weeks.Joint pain and pathological changes were assessed by gait analysis,histology,western blotting and micro-CT.Results:Mg^(2+) and VC showed additive effects to significantly alleviate the joint destruction and pain.The efficacy of this combined therapy could sustain for 3 months after the last injection.We demonstrated that VC enhanced the promotive effect of Mg^(2+) on HIF-1αexpression in cartilage.Additionally,combination of Mg^(2+) and VC markedly promoted the M2 polarization of macrophages in synovium.Furthermore,combination of Mg^(2+) and VC inhibited osteophyte formation and expressions of pain-related neuropeptides.Conclusions:Intra-articular administration of Mg^(2+)and VC additively alleviates joint destruction and pain in OA.Our current formulation may be a cost-effective alternative treatment for OA.

Injectable mechanical pillows for attenuation of load-induced post-traumatic osteoarthritis

Osteoarthritis(OA)of the knee joint is a degenerative disease initiated by mechanical stress that affects millions of individuals.The disease manifests as joint damage and synovial inflammation.Post-traumatic osteoarthritis(PTOA)is a specific form of OA caused by mechanical trauma to the joint.The progression of PTOA is prevented by immediate post-injury therapeutic intervention.Intra-articular injection of anti-inflammatory therapeutics(e.g.corticosteroids)is a common treatment option for OA before end-stage surgical intervention.However,the efficacy of intra-articular injection is limited due to poor drug retention time in the joint space and the variable efficacy of corticosteroids.Here,we endeavored to characterize a four-arm maleimide-functionalized polyethylene glycol(PEG-4MAL)hydrogel system as a‘mechanical pillow’to cushion the load-bearing joint,withstand repetitive loading and improve the efficacy of intra-articular injections of nanoparticles containing dexamethasone,an anti-inflammatory agent.PEG-4MAL hydrogels maintained their mechanical properties after physiologically relevant cyclic compression and released therapeutic payload in an on-demand manner under in vitro inflammatory conditions.Importantly,the on-demand hydrogels did not release nanoparticles under repetitive mechanical loading as experienced by daily walking.Although dexamethasone had minimal protective effects on OA-like pathology in our studies,the PEG-4MAL hydrogel functioned as a mechanical pillow to protect the knee joint from cartilage degradation and inhibit osteophyte formation in an in vivo load-induced OA mouse model.