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1.
Mehmet Nuri Erdem Sinan Karaca Seckin Sarı Feridun Yumrukcal Ruhat Tanli Mehmet Aydogan 《The spine journal》2017,17(3):328-337
Background Context
The application of pedicle screws with cement to strengthen the fixation of the osteoporotic spine has increasingly gained popularity. However, the technique has also led to an increase in cement-related complications.Purpose
The aim of the present study was to compare the clinical and radiological results of the patients with degenerative spinal pathologies who were treated with pedicle screws and cement injections on all segments versus those who were treated with cement injections only on the strategic vertebrae selected.Study Design
A retrospective clinical study.Patient Sample
The sample consists of 31 patients who underwent spinal surgery due to degenerative spinal pathologies.Outcome Measures
Patients were assessed for the adequate spinal fusion and cement-related complication parameters.Methods
Thirty-one patients with a minimum follow-up period of 2 years were divided into two groups and evaluated. Group A consisted of 17 patients (14 females, 3 males; mean age: 68.1 years) with cemented pedicle screws and Group B consisted of 14 patients (12 females, 2 males; mean age: 67.2 years) with cemented screws on selected vertebrae alone. Selection of the strategic vertebrae was made by taking the most stressed regions in the fusion site into account. Prophylactic vertebroplasty was performed in all patients in Group A and on strategic segments in Group B to avoid an adjacent segment fracture. Early- and late-term complications during the follow-up period were recorded.Results
Mean follow-up period was 51.8 (range: 31 to 80) months in Group A and 41.2 (range: 26 to 61) months in Group B. Cemented pedicle screws were bilaterally placed on 94 vertebrae in Group A. In Group B, cement was applied on 28 of 80 vertebrae. Including the prophylactic vertebroplasties, a total of 111 cement applications were performed in Group A and 38 in Group B. Cement embolism, symptomatic chest discomfort, and duration of surgery were significantly higher in Group A (p<.05). No adjacent segment fracture in the proximal or distal vertebra, implant failure, or loss of correction was seen throughout the follow-up period.Conclusions
The application of cemented pedicle screws on all segments of the osteoporotic spine increases the cement volume and rate of cement-related complications. Cementing the strategic vertebrae alone will enhance the fixation strength and endurance and decrease the complications caused by cement application. 相似文献2.
Background Context
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.Purpose
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).Study Design
A randomized controlled trial was performed.Patient Sample
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.Outcome Measures
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.Methods
The LA group (Group L, n=50) received 10?mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10?mL 0.25% bupivacaine+40?mg methylprednisolone at L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.Results
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.Conclusions
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid. 相似文献3.
Genevieve Hill Srinidhi Nagaraja Behrooz A. Akbarnia Jeff Pawelek Paul Sponseller Peter Sturm John Emans Pablo Bonangelino Joshua Cockrum William Kane Maureen Dreher 《The spine journal》2017,17(10):1506-1518
Background Context
Growing rod constructs are an important contribution for treating patients with early-onset scoliosis. These devices experience high failure rates, including rod fractures.Purpose
The objective of this study was to identify the failure mechanism of retrieved growing rods, and to identify differences between patients with failed and intact constructs.Study Design/Setting
Growing rod patients who had implant removal and were previously enrolled in a multicenter registry were eligible for this study.Patient Sample
Forty dual-rod constructs were retrieved from 36 patients across four centers, and 34 of those constructs met the inclusion criteria. Eighteen constructs failed due to rod fracture. Sixteen intact constructs were removed due to final fusion (n=7), implant exchange (n=5), infection (n=2), or implant prominence (n=2).Outcome Measures
Analyses of clinical registry data, radiographs, and retrievals were the outcome measures.Methods
Retrievals were analyzed with microscopic imaging (optical and scanning electron microscopy) for areas of mechanical failure, damage, and corrosion. Failure analyses were conducted on the fracture surfaces to identify failure mechanism(s). Statistical analyses were performed to determine significant differences between the failed and intact groups.Results
The failed rods fractured due to bending fatigue under flexion motion. Construct configuration and loading dictate high bending stresses at three distinct locations along the construct: (1) mid-construct, (2) adjacent to the tandem connector, or (3) adjacent to the distal anchor foundation. In addition, high torques used to insert set screws may create an initiation point for fatigue. Syndromic scoliosis, prior rod fractures, increase in patient weight, and rigid constructs consisting of tandem connectors and multiple crosslinks were associated with failure.Conclusion
This is the first study to examine retrieved, failed growing rod implants across multiple centers. Our analysis found that rod fractures are due to bending fatigue, and that stress concentrations play an important role in rod fractures. Recommendations are made on surgical techniques, such as the use of torque-limiting wrenches or not exceeding the prescribed torques. Additional recommendations include frequent rod replacement in select patients during scheduled surgeries. 相似文献4.
Kevin Phan Jun S. Kim Nathan J. Lee Sulaiman Somani John Di Capua Parth Kothari Dante Leven Samuel K. Cho 《The spine journal》2017,17(4):538-544
Background Context
Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus nonelderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF).Purpose
The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF.Study Design
Secondary analysis of prospectively collected data.Patient Sample
Patients undergoing ALIF in the National Surgical Quality Improvement Program (NSQIP) participant files for the period 2010 through 2014.Outcomes Measures
Outcome measures included any postoperative complication, return to operating room (OR), and length of stay >5 days.Methods
NSQIP participant files from 2010 to 2014 were used to identify patients undergoing ALIF. The mFI used in the present study is an 11-variable assessment that maps 16 NSQIP variables to 11 variables in the Canadian Study of Health and Ageing Frailty Index. Univariate analysis and multivariable logistic regression models were used to compare the relative strength of association between mFI with outcome variables of interest.Results
In total, 3,920 ALIF cases were identified and grouped according to their mFI score: 0 (n=2,025), 0.09 (n=1,382), 0.18 (n=464), or ≥0.27 (n=49). As the mFI increased from 0 (no frailty-associated variables) to 0.27 (4 of 11) or higher, there was a significant stepwise increase in any complication from 10.8% to 32.7%. After multivariable regression analysis, no significant association was found between higher mFI scores with urinary tract infections and venous thromboembolism. High frailty scores were significant predictors of any complication (mFI of ≥0.27 [reference: 0]; OR 2.4; p=.040) and pulmonary complications (mFI score ≥0.27; OR 7.5; p=.001).Conclusions
In summary, high mFI scores were found to be independently associated with any complication and pulmonary complications in patients who underwent ALIF. The use of mFI together with traditional risk factors may help better identify high-surgical risk patients, which may be useful for preoperative and postoperative care optimization. 相似文献5.
Minji K. Lee Kathleen J. Yost Jennifer S. McDonald Ryne W. Dougherty Roanna L. Vine David F. Kallmes 《The spine journal》2017,17(6):821-829
Background Context
The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability.Purpose
To evaluate the psychometric quality of the RMDQ in patients with severe disability.Study Design/Setting
Observational clinical study.Sample
The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty.Outcome Measures
The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up.Methods
With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID).Results
Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods.Conclusions
Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. 相似文献6.
Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality
M. Martín-Fernández A. López-Herradón A.R. Piñera F. Tomé-Bermejo J.M. Duart M.D. Vlad M.G. Rodríguez-Arguisjuela L. Alvarez-Galovich 《The spine journal》2017,17(8):1192-1199
Background Context
Dramatic increases in the average life expectancy have led to increases in the variety of degenerative changes and deformities observed in the aging spine. The elderly population can present challenges for spine surgeons, not only because of increased comorbidities, but also because of the quality of their bones. Pedicle screws are the implants used most commonly in spinal surgery for fixation, but their efficacy depends directly on bone quality. Although polymethyl methacrylate (PMMA)-augmented screws represent an alternative for patients with osteoporotic vertebrae, their use has raised some concerns because of the possible association between cement leakages (CLs) and other morbidities.Purpose
To analyze potential complications related to the use of cement-augmented screws for spinal fusion and to investigate the effectiveness of using these screws in the treatment of patients with low bone quality.Study Design
A retrospective single-center study.Patient Sample
This study included 313 consecutive patients who underwent spinal fusion using a total of 1,780 cement-augmented screws.Methods and Outcome Measures
We analyzed potential complications related to the use of cement-augmented screws, including CL, vascular injury, infection, screw extraction problems, revision surgery, and instrument failure. There are no financial conflicts of interest to report.Results
A total of 1,043 vertebrae were instrumented. Cement leakage was observed in 650 vertebrae (62.3%). There were no major clinical complications related to CL, but two patients (0.6%) had radicular pain related to CL at the S1 foramina. Of the 13 patients (4.1%) who developed deep infections requiring surgical debridement, two with chronic infections had possible spondylitis that required instrument removal. All patients responded well to antibiotic therapy. Revision surgery was performed in 56 patients (17.9%), most of whom had long construction. A total of 180 screws were removed as a result of revision. There were no problems with screw extraction.Conclusions
These results demonstrate the efficacy and safety of cement-augmented screws for the treatment of patients with low bone mineral density. 相似文献7.
Shujie Wang Yang Yang Jianguo Zhang Ye Tian Jianxiong Shen Shengru Wang 《The spine journal》2017,17(1):76-80
Background Context
Intraoperative monitoring (IOM) is an essential method for preventing postoperative spinal deficits during posterior vertebral column resection (VCR) surgery for treatment of severe spine deformities, but the IOM features directing at VCR procedures are rarely reported and need to be further clarified.Purpose
To evaluate an important surgical point that will lead to the IOM loss frequently, and then remind the surgeons to pay close attention to impending monitoring changes during posterior VCR surgery.Study Design/Setting
Retrospective study.Patient Sample
A total of 77 patients with severe spine deformities who underwent posterior VCR and deformity correction surgeries from January 2012 to May 2015 are retrospectively analyzed in our spine center.Outcome Measures
IOM (motor-evoked potentials [MEP] and somatosensory-evoked potentials) was used for intraoperative spinal function assessment.Methods
Patients were divided into 2 groups according to their preoperative spinal function, including 27 patients with preoperative spinal deficits and 50 patients with spinal normal. And the IOM data during surgery, especially among VCR procedures, were mainly analyzed in the present study.Results
With the VCR procedure almost complete, most patients showed varying degrees of IOM loss that included 37 cases showing obvious IOM degenerations and 21 cases showing significant IOM loss with alerts immediately. Moreover, the patients with preoperative spinal deficits have more significant decreasing percentage in MEP amplitude (81% vs. 68%, p<.05) than those patients without.Conclusions
With the VCR procedure almost complete, surgeons must pay closely attention to the IOM signals and should be ready to take corresponding surgical measures to deal with the impeding monitoring loss. 相似文献8.
Donald E. Fry Susan M. Nedza Michael Pine Agnes M. Reband Chun-Jung Huang Gregory Pine 《The spine journal》2017,17(11):1641-1649
Background Context
Elective spine surgery is a commonly performed operative procedure, that requires knowledge of risk-adjusted results to improve outcomes and reduce costs.Purpose
To develop risk-adjusted models to predict the adverse outcomes (AOs) of care during the inpatient and 90-day post-discharge period for spine fusion surgery.Study Design/Setting
To identify the significant risk factors associated with AOs and to develop risk models that measure performance.Patient Sample
Hospitals that met minimum criteria of both 20 elective cervical and 20 elective non-cervical spine fusion operations in the 2012–2014 Medicare limited dataset.Outcome Measures
The risk-adjusted AOs of inpatient deaths, prolonged length-of-stay for the index hospitalization, 90-day post-discharge deaths, and 90-day post-discharge readmissions were dependent variables in predictive risk models.Methods
Over 500 candidate risk factors were used for logistic regression models to predict the AOs. Models were then used to predicted risk-adjusted AO rates by hospitals.Results
There were 874 hospitals with a minimum of both 20 cervical and 20 non-cervical spine fusion patients. There were 167,395 total cases. A total of 7,981 (15.9%) of cervical fusion patients and 17,481 (14.9%) of non-cervical fusion patients had one or more AOs for an overall AO rate of 15.2%. A total of 54 hospitals (6.2%) had z-scores that were 2.0 better than predicted with a median risk adjusted AO rate of 9.2%, and 75 hospitals (8.6%) were 2.0 z-scores poorer than predicted with a median risk-adjusted AO rate of 23.2%.Conclusions
Differences among hospitals defines opportunities for care improvement. 相似文献9.
Michael K. Urban Kara Fields Sean W. Donegan Jonathan C. Beathe David W. Pinter Oheneba Boachie-Adjei Ronald G. Emerson 《The spine journal》2017,17(12):1889-1896
Background Context
Lidocaine has emerged as a useful adjuvant anesthetic agent for cases requiring intraoperative monitoring of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). A previous retrospective study suggested that lidocaine could be used as a component of propofol-based intravenous anesthesia without adversely affecting MEP or SSEP monitoring, but did not address the effect of the addition of lidocaine on the MEP and SSEP signals of individual patients.Purpose
The purpose of this study was to examine the intrapatient effects of the addition of lidocaine to balanced anesthesia on MEPs and SSEPs during multilevel posterior spinal fusion.Study Design
This is a prospective, two-treatment, two-period crossover randomized controlled trial with a blinded primary outcome assessment.Patient Sample
Forty patients undergoing multilevel posterior spinal fusion were studied.Outcome Measures
The primary outcome measures were MEP voltage thresholds and SSEP amplitudes. Secondary outcome measures included isoflurane concentrations and hemodynamic parameters.Methods
Each participant received two anesthetic treatments (propofol 50?mcg/kg/h and propofol 25?mcg/kg/h+lidocaine 1?mg/kg/h) along with isoflurane, ketamine, and diazepam. In this manner, each patient served as his or her own control. The order of administration of the two treatments was determined randomly.Results
There were no significant within-patient differences between MEP threshold voltages or SSEP amplitudes during the two anesthetic treatments.Conclusions
Lidocaine may be used as a component of balanced anesthesia during multilevel spinal fusions without adversely affecting the monitoring of SSEPs or MEPs in individual patients. 相似文献10.
Hiroyuki Aono Keisuke Ishii Hidekazu Tobimatsu Yukitaka Nagamoto Shota Takenaka Masayuki Furuya Horii Chiaki Motoki Iwasaki 《The spine journal》2017,17(8):1113-1119
Background Context
Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate.Purpose
The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty.Study Design
This is a prospective multicenter comparative study.Patient Sample
We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty.Outcome Measures
Radiological parameters (Cobb angle on standing lateral radiographs) were used.Methods
Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively.Results
After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty.Conclusions
Temporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma. 相似文献11.
Ronald H.M.A. Bartels Roland D. Donk Wim I.M. Verhagen Allard J.F. Hosman André L.M. Verbeek 《The spine journal》2017,17(11):1625-1632
Background Context
The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance.Purpose
This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis.Study Design
This study is a review of the literature.Patient Sample
This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty.Outcome Measure
The outcome measure used in the study was the MCID.Methods
We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature.Results
We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance.Conclusions
The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement. 相似文献12.
Vincent J. Alentado Stephanie Caldwell Heath P. Gould Michael P. Steinmetz Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(2):236-243
Background Context
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.Purpose
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study Design
This is a retrospective review of patients who underwent instrumented lumbar fusion.Patient Sample
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome Measures
Outcome measures included preoperative and postoperative EQ-5D Index scores.Materials and Methods
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.Results
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.Conclusions
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively. 相似文献13.
Takeshi Oichi Hirotaka Chikuda Junichi Ohya Ryo Ohtomo Kojiro Morita Hiroki Matsui Kiyohide Fushimi Sakae Tanaka Hideo Yasunaga 《The spine journal》2017,17(4):531-537
Background Context
There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).Purpose
This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes.Study Design
This is a retrospective matched-pair cohort study.Patient Sample
Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.Outcome Measures
In-hospital mortality and occurrence of postoperative complications.Methods
For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data.Results
Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37–2.22; p<.001).Conclusions
Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication. 相似文献14.
Erik Van de Kelft Gino Verleye An-Sofie Van de Kelft Koen Melis Johan Van Goethem 《The spine journal》2017,17(10):1457-1463
Background Context
The evidence for the treatment for nonspecific chronic low back pain (ns CLBP) is very weak. Besides the complexity of the pain experience, a good biological marker or tool enabling identification of a pain generator is lacking. Hybrid imaging, combining single-photon emission computerized tomography (SPECT) with computerized tomography (CT) scan, has been proposed as useful in the diagnostic workup of patients with CLBP.Purpose
To evaluate the sensitivity of SPECT-CT in patients with ns CLBP (Group I) as compared with patients without CLBP (Group II).Study Design
A prospective comparative study.Patient Sample
Two hundred patients were enrolled: 96 in Group I and 104 in Group II.Outcome Measures
Only the physiological measurement of the incidence of hot spots was performed.The hot spots were rated as follows: 0=normal; 1=slightly colored (no hot spot on whole-body bone scan); and 2=clear hot spot (can be identified on the whole-body bone scan and confirmed on SPECT). To analyze the interobserver agreement when using this scoring system, a second independent reading was performed for 50 randomly chosen records.Methods
Two hundred patients divided into two groups were referred to the department of Medical and Molecular Imaging for a topographic SPECT-CT.The first group consisted of patients with ns CLBP, diagnosed by a neurosurgeon. The control group consisted of patients referred for SPECT-CT for non-spinal conditions. Hot spots were assessed for all patients.A second independent reading, blinded for the results of the first reader, was performed on 25 randomly selected patients in each group.This study was investigator initiated, and no funding was received. None of the authors or their proxies have a potential conflict of interest.Results
The odds of finding a normal image in the control group are 2.05 times higher than in Group I. The sensitivity score equals 2.37, meaning that the probability of detecting a hot spot (levels 1 or 2) is more than two times higher in Group I. When focusing on level 2 hot spots only, this score rises to 7.02, indicative of a high sensitivity.Conclusions
Single-photon emission computerized tomography with computerized tomography might have potential in the diagnostic workup of patients with ns CLBP, owing to its higher sensitivity when compared with other advanced medical imaging modalities. 相似文献15.
Dustin B. Wygant Paul A. Arbisi Kevin J. Bianchini Robert L. Umlauf 《The spine journal》2017,17(4):505-510
Background Context
Waddell et al. identified a set of eight non-organic signs in 1980. There has been controversy about their meaning, particularly with respect to their use as validity indicators.Purpose
The current study examined the Waddell signs in relation to measures of somatic amplification or over-reporting in a sample of outpatient chronic pain patients. We examined the degree to which these signs were associated with measures of over-reporting.Study Design/Setting
This study examined scores on the Waddell signs in relation to over-reporting indicators in an outpatient chronic pain sample.Patient Sample
We examined 230 chronic pain patients treated at a multidisciplinary pain clinic. The majority of these patients presented with primary back or spinal injuries.Outcome Measures
The outcome measures used in the study were Waddell signs, Modified Somatic Perception Questionnaire, Pain Disability Index, and the Minnesota Multiphasic Personality Inventory-2 Restructured Form.Methods
We examined Waddell signs using multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA), receiver operating characteristic analysis, classification accuracy, and relative risk ratios.Results
Multivariate analysis of variance and ANOVA showed a significant association between Waddell signs and somatic amplification. Classification analyses showed increased odds of somatic amplification at a Waddell score of 2 or 3.Conclusions
Our results found significant evidence of an association between Waddell signs and somatic over-reporting. Elevated scores on the Waddell signs (particularly scores higher than 2 and 3) were associated with increased odds of exhibiting somatic over-reporting. 相似文献16.
Sungjoon Lee Chi Heon Kim Chun Kee Chung Sung Bae Park Seung Heon Yang Soo Hyun Kim Soohee Kang Ju Hee Lee Yunhee Choi 《The spine journal》2017,17(4):469-477
Background Context
Postoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients.Purpose
The aim of the present study was to determine the incidence of and risk factors for POUR.Study Design/Setting
This is a retrospective nested case-control study.Patient Sample
A total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed.Outcome Measures
A multivariable logistic model was utilized to identify risk factors.Methods
A systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4–6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100?mL for more than 2 days after surgery.Results
The incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029–1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001–1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684).Conclusion
POUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries. 相似文献17.
E. Kyung Shin Chi Heon Kim Chun Kee Chung Yunhee Choi Dahae Yim Whei Jung Sung Bae Park Jung Hyeon Moon Won Heo Sung-Mi Kim 《The spine journal》2017,17(2):175-182
Background Context
Lumbar spinal stenosis (LSS) is the most common lumbar degenerative disease, and sagittal imbalance is uncommon. Forward-bending posture, which is primarily caused by buckling of the ligamentum flavum, may be improved via simple decompression surgery.Purpose
The objectives of this study were to identify the risk factors for sagittal imbalance and to describe the outcomes of simple decompression surgery.Study Design
This is a retrospective nested case-control studyPatient Sample
This was a retrospective study that included 83 consecutive patients (M:F=46:37; mean age, 68.5±7.7 years) who underwent decompression surgery and a minimum of 12 months of follow-up.Outcome Measures
The primary end point was normalization of sagittal imbalance after decompression surgery.Methods
Sagittal imbalance was defined as a C7 sagittal vertical axis (SVA) ≥40?mm on a 36-inch-long lateral whole spine radiograph. Logistic regression analysis was used to identify the risk factors for sagittal imbalance. Bilateral decompression was performed via a unilateral approach with a tubular retractor. The SVA was measured on serial radiographs performed 1, 3, 6, and 12 months postoperatively. The prognostic factors for sagittal balance recovery were determined based on various clinical and radiological parameters.Results
Sagittal imbalance was observed in 54% (45/83) of patients, and its risk factors were old age and a large mismatch between pelvic incidence and lumbar lordosis. The 1-year normalization rate was 73% after decompression surgery, and the median time to normalization was 1 to 3 months. Patients who did not experience SVA normalization exhibited low thoracic kyphosis (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02–1.10) (p<.01) and spondylolisthesis (HR, 0.33; 95% CI, 0.17–0.61) before surgery.Conclusions
Sagittal imbalance was observed in more than 50% of LSS patients, but this imbalance was correctable via simple decompression surgery in 70% of patients. 相似文献18.
Joshua Bakhsheshian Ben A. Strickland Neil N. Patel Andre M. Jakoi Michael Minneti Gabriel Zada Frank L. Acosta Patrick C. Hsieh Jeffrey C. Wang John C. Liu Martin H. Pham 《The spine journal》2017,17(9):1335-1341
Background Context
Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery.Purpose
The study aimed to describe a perfusion-based cadaveric simulation model with cerebrospinal fluid (CSF) reconstitution and to compare spine dural repair techniques.Study Design/Setting
The study is set in a fresh tissue dissection laboratory.Sample Size
The sample includes eight fresh human cadavers.Outcome Measures
A watertight closure was achieved when pressurized saline up to 40?mm?Hg did not cause further CSF leakage beyond the suture lines.Methods
Fresh human cadaveric specimens underwent cannulation of the intradural cervical spine for intrathecal reconstitution of the CSF system. The cervicothoracic dura was then exposed from C7–T12 via laminectomy. The entire dura was then opened in six cadavers (ALLSPINE) and closed with 6-0 Prolene (n=3) or 4-0 Nurolon (n=3), and pressurized with saline via a perfusion system to 60?mm?Hg to check for leakage. In two cadavers (INCISION), six separate 2-cm incisions were made and closed with either 6-0 Prolene or 4-0 Nurolon, and then pressurized. A hydrogel sealant was then added and the closure was pressurized again to check for further leakage.Results
Spinal laminectomy with repair of intentional durotomy was successfully performed in eight cadavers. The operative microscope was used in all cases, and the model provided a realistic experience of spinal durotomy repair. For ALLSPINE cadavers (mean: 240?mm dura/cadaver repaired), the mean pressure threshold for CSF leakage was observed at 66.7 (±2.9) mm?Hg in the 6-0 Prolene group and at 43.3 (±14.4) mm?Hg in the 4-0 Nurolon group (p>.05). For INCISION cadavers, the mean pressure threshold for CSF leakage without hydrogel sealant was significantly higher in 6-0 Prolene group than in the 4-0 Nurolon group (6-0 Prolene: 80.0±4.5?mm?Hg vs. 4-0 Nurolon: 32.5±2.7?mm?Hg; p<.01). The mean pressure threshold for CSF leakage with the hydrogel sealants was not significantly different (6-0 Prolene: 100.0±0.0?mm?Hg vs. 4-0 Nurolon: 70.0±33.1?mm?Hg). The use of a hydrogel sealant significantly increased the pressure thresholds for possible CSF leakage in both the 6-0 Prolene group (p=.01) and the 4-0 Nurolon group (p<.01) when compared with mean pressures without the hydrogel sealant.Conclusions
We described the feasibility of using a novel cadaveric model for both the study and training of watertight dural closure techniques. 6-0 Prolene was observed to be superior to 4-0 Nurolon for watertight dural closure without a hydrogel sealant. The use of a hydrogel sealant significantly improved watertight dural closures for both 6-0 Prolene and 4-0 Nurolon groups in the cadaveric model. 相似文献19.
Permsak Paholpak Alexander Nazareth Patrick C. Hsieh Zorica Buser Jeffrey C. Wang 《The spine journal》2017,17(9):1272-1284
Background Context
T1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited.Purpose
(1) To evaluate the T1 slope, cervical sagittal alignment, and thoracic inlet parameter in patients with DCS using kinematic magnetic resonance imaging (kMRI), and (2) to find a correlation between the T1 slope, TI, and other cervical sagittal parameters in patients with DCS.Design/Setting
Retrospective kMRI study, Level III.Patient Sample
Fifty-two patients with DCS from 1,128 patients from a cervical kMRI database.Outcome Measures
T1 slope, C2–C7 angle, sagittal vertical axis C2–C7 (SVA C2–C7), cranial tilt, cervical tilt, neck tilt, and thoracic inlet angle (TIA).Methods
Cervical spine kMRIs of 52 patients with DCS (mean age 51.7±standard deviation) were analyzed in neutral, flexion, and extension positions. Patients with DCS were divided into two groups: anterolisthesis (N=33) and retrolisthesis (N=19). Each listhesis group was subclassified into grade 1 (slip 2–3?mm) and grade 2 (slip>3?mm).Results
Grade 2 retrolisthesis had the largest T1 slope followed by grade 1 retrolisthesis, grade 2 anterolisthesis, and grade 1 anterolisthesis. Significant differences were found between the anterolisthesis and the retrolisthesis groups in the neutral position (p=.025). The flexion position had the largest T1 slope and showed a significant difference with anterolisthesis in the neutral position (p=.041). Sagittal vertical axis C2–C7 showed strong correlation with cranial tilt in all DCS groups and all positions.Conclusions
In our study, T1 slope was larger in grade 2 DCS, and the retrolisthesis group had larger T1 slope than the anterolisthesis group. Presence of larger T1 slope was significantly correlated with larger cervical lordosis curvature. Furthermore, cranial tilt was strongly correlated with SVA C2–C7. 相似文献20.
Juan A. Sanchis-Gimeno Susanna Llido David Guede Francisco Martinez-Soriano Jose Ramon Caeiro Esther Blanco-Perez 《The spine journal》2017,17(3):431-434