Klinik Sonnenhof

Anterior lumbar interbody fusion (ALIF) is a well-established procedure for the treatment of spondylosis, spondylolisthesis, and degenerative disc disease but can cause sexual dysfunction and retrograde ejaculation (RE). We assessed the occurrence of sexual dysfunction and RE and explored associations between patient and surgical characteristics with sexual dysfunction, RE, and patient satisfaction with the outcome of surgery. This is a retrospective survey study. A short questionnaire on changes in sexual function, RE, and patient satisfaction was sent to 170 male patients aged 18 to 60 years who underwent a primary ALIF at L5/S1, L4/L5, or both via retroperitoneal approach between 2015 and 2020 in a high-volume spine centre in Switzerland. Factors associated with changes in sexual function and with RE were examined in univariable and multivariable logistic regressions. The multivariable logistic regression model was adjusted for age at surgery, time since surgery, level of surgery, and fusion material. The associations between satisfaction with the outcome of surgery and time since surgery and changes in sexual function were also assessed using univariable logistic regression. Of the 170 patients contacted, 98 (58%) agreed to participate. The most frequent fusion level was L5/S1 (n = 74, 76% of respondents), and InductOs was generally used (n = 69, 70%). Overall, 21 patients (21%) reported changes in sexual function, and 11 (11%) felt signs of RE. The majority of patients were satisfied with the surgical outcome (n = 83, 85%) and would undergo the surgery again (n = 83, 85%). In all regression models, changes in sexual function and RE were not associated with any of the studied factors. The odds of being satisfied with the surgery were 4× higher for patients who did not observe changes in sexual function than those who did (95% CI, 1.24-12.86). The risk of sexual dysfunction and RE after ALIF is relevant, and patients need to be adequately informed about these complications, especially if they want to have children. At the same time, the ALIF procedure remains a successful treatment option with high patient satisfaction. The study emphasizes the need to provide patients with adequate information regarding ALIF surgery.

Distal radius fractures are among the most common fracture sites, with a high incidence across all age groups. High-resolution peripheral quantitative computed tomography (HR-pQCT) has enabled assessment of bone microarchitecture in vivo at the distal radius, providing new insights into the healing process. However, we have observed structural bone loss that is not captured by standard analysis. This study uses void space analysis to quantify the development of localized structural bone loss during fracture healing. Twenty-six participants (21 female, 5 male; aged 18-79 yr) with conservatively-treated distal radius fractures were scanned using HR-pQCT at 6 study visits post-fracture (wk 1, 3, 5, 12, 26, and 52). Total BMD (Tt.BMD), bone volume fraction (BV/TV), and void space volume fraction (VS/TV) were measured. Grip strength relative to the non-fractured wrist and patient rated wrist evaluation (PRWE) were measured at all study visits after cast removal. The cumulative expansion of VS/TV across sequential study visits was quantified to differentiate voids that developed during healing from pre-existing void space. A 5-fold increase in median VS/TV was observed during the follow-up period, from 1.0% (0.6%-9.0%) to 5.5% (2.5%-12.4%). Tt.BMD and BV/TV did not significantly change in this same time interval. Relative grip strength after cast removal was significantly inversely correlated with final VS/TV (⍴ = −0.63, p = .02) and cumulative expansion of new void space during healing (R = −0.67, p <.01), whereas no significant associations were found with age or PRWE. This study suggests that there are adverse changes in bone microarchitecture during fracture healing, despite the preservation of overall Tt.BMD and BV/TV in the same region. Reduced grip strength is correlated with more severe void space formation, but the mechanistic relationship requires further exploration. The formation of void spaces may have long-term implications on bone strength and could provide insight into risk of re-fracture.

IntroductionIn daily clinical practice, progression of spinal fusion is typically monitored during clinical follow-up using conventional radiography and Computed Tomography scans. However, recent research has demonstrated the potential of implant load monitoring to assess posterolateral spinal fusion in an in-vivo sheep model. The question arises to whether such a strain sensing system could be used to monitor bone fusion following lumbar interbody fusion surgery, where the intervertebral space is supported by a cage. Therefore, the aim of this study was to test human cadaveric lumbar spines in two states: after a transforaminal lumbar interbody fusion (TLIF) procedure combined with a pedicle-screw-rod-construct (PSR) and subsequently after simulating bone fusion. The study hypothesized that the load on the posterior instrumentation decreases as the segment stiffens due to simulated fusion.MethodA TLIF procedure with PSR was performed on eight human cadaveric spines at level L4-L5. Strain sensors were attached bilaterally to the rods to derive implant load changes during unconstrained flexion-extension (FE), lateral bending (LB) and axial rotation (AR) loads up to ±7.5Nm. The specimens were retested after simulating bone fusion between vertebrae L4-L5. In addition, the range of motion (ROM) was measured during each loading mode.ResultThe ROM decreased in the simulated bone fusion state in all loading directions (p≤0.002). In both states, the measured strain on the posterior instrumentation was highest during LB motion. Furthermore, the sensors detected a significant decrease in the load induced rod strain (p≤0.002) between TLIF+PSR and simulated bone fusion state in LB.ConclusionImplant load measured via rod strain sensors can be used to monitor the progression of fusion after a TLIF procedure when measured during LB of the lumbar spine. However, further research is needed to investigate the influence of daily loading scenarios expected in-vivo on the overall change in implant load.

Elevated LDL cholesterol remains one of the most important cardiovascular risk factors. For this reason, great scientific efforts have been made in recent decades to reduce elevated LDL cholesterol levels. After statins, ezetrol, and PCSK9 inhibitors, bempedoic acid is a new promising option for the treatment of LDL-cholesterol. Bempedoic acid is an inhibitor of adenosine triphosphate citrate lyase (ACL), an enzyme that converts citrate to acetyl-CoA in the cytosol. The active ingredient thus attacks the above HMG-CoA reductase, the target of statins, in the mevalonate/cholesterol biosynthesis pathway. Bempedoic acid can be considered a prodrug that is converted intracellularly to ETC-1002-CoA by ACSVL1 (very long-chain acyl-CoA synthetase 1) via coenzyme A (CoA) activation. ACSVL1 is primarily expressed in the liver and not in skeletal muscle. Therefore, in contrast to statins, it is not associated with muscle pain, which is one of the great advantages of this drug.

Data sharing is not applicable to this article as no new data were created or analyzed in this paper.