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1.
Wang Chongyan Xuyang Zhang Shengyun Li Junhui Liu Zhi Shan Jiasheng Wang Jian Chen Shunwu Fan Fengdong Zhao 《The spine journal》2018,18(12):2297-2301
BACKGROUND CONTEXT
Intravertebral clefts (IVCs) are vacuum-like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain.PURPOSE
The present study aims to create IVCs in mechanical experiments on cadaveric spines in order to clarify their pathogenesis, structure, and links with the basivertebral foramen.STUDY DESIGN AND METHODS
In total, 15 three-vertebra lumbar specimens from five cadavers aged 68 to 71 years were subjected to axial compressive overload followed by cyclic loading in flexion and extension to create an OVCF together with an IVC. Computed tomography scans and radiographs were used to confirm structural changes and micro-CT was used to measure trabecular bone properties in five specimens. Unipedicular vertebroplasty was then performed on 10 damaged specimens until fluoroscopy revealed extravasation of cement.RESULTS
In every specimen, loading created an OVCF with an IVC. Dissection and imaging showed that the IVC was always connected with the basivertebral foramen. The central vertebral region, including the IVC, had the lowest connectivity density, trabecular number, and bone volume fraction, and the highest trabecular separation. Vertebroplasty caused cement leakage through the basivertebral foramen in nine specimens and into an adjacent disc in one specimen.CONCLUSION
Cyclic loading in flexion and extension applied to a fractured osteoporotic vertebra can create an IVC, which then allows cement leakage via the basivertebral foramen. 相似文献2.
Charles H. Crawford Steven D. Glassman Mladen Djurasovic R. Kirk Owens Jeffrey L. Gum Leah Y. Carreon 《The spine journal》2019,19(2):187-190
BACKGROUND CONTEXT
Previous studies suggest that a postoperative symptom state with Oswestry Disability Index (ODI)≤20 and pain Numeric Rating Scales (NRS)≤2 following surgery for lumbar degenerative conditions are reasonable thresholds for best outcomes in which patients will be unlikely to seek additional medical care or require additional health-care resources.PURPOSE
To identify prognostic factors that predict a “best outcome,” defined as postoperative ODI≤20 and pain NRS≤2 following fusion for lumbar degenerative conditions.STUDY DESIGN
Longitudinal observational cohort.PATIENT SAMPLE
A total of 396 patients from a single site enrolled in the Quality Outcomes Database who underwent fusion for lumbar degenerative conditions.Outcome Measures
Oswestry Disability Index, Back and Leg Pain NRS (0–10).METHODS
Collected and analyzed variables included age, sex, body mass index, American Society of Anesthesia grade, number of surgical levels, surgical time, preoperative ODI, preoperative back pain, preoperative leg pain, workmen compensation status, surgical approach, smoking status, and principal diagnosis.RESULTS
A total of 74 patients (19%) reported a minimal symptom state at 1-year postoperative (ODI≤20, back pain NRS≤2, and leg pain NRS≤2) and were included in the best outcomes group. Patients in the best outcomes group were older (62 vs. 57 years, p=.001), had lower preoperative ODI (43 vs. 56, p=.000), lower preoperative back pain (6.5 vs. 7.5, p=.000). They had fewer surgical levels (1.25 vs. 1.47, p=.005) and shorter operative times [OR] times (208 vs. 241 minutes, p=.002). They were more likely to have a preoperative diagnosis of spondylolisthesis or disc herniation and less likely to have a diagnosis of adjacent segment disease or mechanical disc collapse (p=.001). Stepwise forward regression analysis revealed diagnosis (p=.023, OR=0.75), age (p=.000, OR=1.04), baseline ODI (p=.000, OR=0.96), and number of levels (p=.019, OR=0.53) as predictive variables.CONCLUSION
Achieving a minimal symptom state, defined here as a postoperative ODI≤20 and pain NRS≤2, following fusion for lumbar degenerative conditions is more likely in an older patient with a lower baseline ODI undergoing a single level lumbar fusion for spondylolisthesis. 相似文献3.
BACKGROUND CONTEXT
Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.PURPOSE
This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis.STUDY DESIGN/SETTING
A retrospective comparative study.PATIENT SAMPLE
PVO patients with osteoporosis.OUTCOME MEASURES
Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.METHODS
PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest.RESULTS
A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p?=?.014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p?=?.001 for model 1 and p?=?.002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups.CONCLUSIONS
Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery. 相似文献4.
Nuno Rui Paulino Pereira Paul T. Ogink Olivier Q. Groot Marco L. Ferrone Francis J. Hornicek C.N. van Dijk J.A.M. Bramer Joseph H. Schwab 《The spine journal》2019,19(1):144-156
Background Context
Postoperative morbidity may offset the potential benefits of surgical treatment for spine metastatic disease; hence, risk factors for postoperative complications and reoperations should be taken into considerations during surgical decision-making. In addition, it remains unknown whether complications and reoperations shorten these patients' survival.Purpose
We aimed to describe and identify factors associated with having a complication within 30 days of index surgery as well as factors associated with having a subsequent reoperation. Furthermore, we assessed the effect of 30-day complications and reoperations on the patients' postoperative survival, as well as described neurologic changes after surgery.Study Design
Retrospective cohort study.Patient Sample
We included 647 patients 18 years and older who had surgery for metastatic disease in the spine between January 2002 and January 2014 in one of two affiliated tertiary care centers.Outcome Measures
Our primary outcomes were complications within 30 days after surgery and reoperations until final follow-up or death.Methods
We used multivariate logistic regression to identify risk factors for 30-day complications and reoperations. We used the Cox regression analysis to assess the effect of postoperative complications and reoperations on survival.Results
From 647 included patients, 205 (32%) had a complication within 30 days. The following variables were independently associated with 30-day complications: lower albumin levels (odds ratio [OR]: 0.69, 95% confidence interval [CI]=0.49–0.96, p=.021), additional comorbidities (OR=1.42, 95% CI=1.00–2.01, p=.048), pathologic fracture (OR=1.41, 95% CI=0.97–2.05, p=.031), three or more spine levels operated upon (OR=1.64, 95% CI=1.02–2.64, p=.027), and combined surgical approach (OR=2.44, 95% CI=1.06–5.60, p=.036). One hundred and fifteen patients (18%) had at least one reoperation after the initial surgery; prior radiotherapy (OR=1.56, 95% CI=1.07–2.29, p=.021) to the spinal tumor was independently associated with reoperation. 30-day complications were associated with worse survival (hazard ratio [HR]=1.40, 95% CI=1.17–1.68, p<.001), and reoperation was not significantly associated with worse survival (HR=0.80, 95% CI=0.09–1.00, p=.054). Neurologic status worsened in 42 (6.7%), remained stable in 445 (71%), and improved in 140 (22%) patients after surgery.Conclusions
Three or more spine levels operated upon and prior radiotherapy should prompt consideration of a preoperative plastic surgery consultation regarding soft tissue coverage. Furthermore, if time allows, aggressive nutritional supplementation should be considered for patient with low preoperative serum albumin levels. Surgeons should be aware of the increase in complications in patients presenting with pathologic fracture, undergoing a combined approach, and with any additional preoperative comorbidities. Importantly, 30-day complications were associated with worsened survival. 相似文献5.
Alisson R. Teles Don Daniel Ocay Abdulaziz Bin Shebreen Andrew Tice Neil Saran Jean A. Ouellet Catherine E. Ferland 《The spine journal》2019,19(4):677-686
BACKGROUND CONTEXT
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.PURPOSE
To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.STUDY DESIGN
Cross-sectional study.PATIENT SAMPLE
Ninety-four patients diagnosed with AIS and chronic back pain.OUTCOME MEASURES
Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.METHODS
Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.RESULTS
Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048).CONCLUSIONS
Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome. 相似文献6.
Shingo Morishita Toshitaka Yoshii Atsushi Okawa Kiyohide Fushimi Takeo Fujiwara 《The spine journal》2019,19(4):610-616
BACKGROUND CONTEXT
Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.PURPOSE
To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database.STUDY DESIGN
A retrospective cohort study with propensity score matching analysis.PATIENT SAMPLE
Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed.OUTCOME MEASURES
The occurrence of postoperative complications during hospitalization.METHODS
We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis.RESULTS
One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups.CONCLUSION
The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group. 相似文献7.
Y. Zhao R. Xue N. Shi Y. Xue Y. Zong W. Lin B. Pei C. Sun R. Fan Y. Jiang 《Osteoporosis international》2016,27(11):3309-3317
Summary
Patients with spinal cord deficits following new unstable osteoporotic compression fracture and surgical contraindications were considered to receive conservative treatment. Teriparatide was better than alendronate at improving bone mineral density and bone turnover parameters, as well as preventing aggravation of spinal cord compromise.Introduction
This study compared the preventive effects of teriparatide and alendronate on aggravation of spinal cord compromise following new unstable osteoporotic vertebral compression fracture (OVCF) in patients with surgical contraindications.Methods
This was a 12-month, randomized, open-label study of teriparatide versus alendronate in 49 patients with new unstable OVCF and surgical contraindications. Neurological function was evaluated using modified Japanese Orthopedic Association (mJOA) score (11-point scale, the maximum score of 11 implies normalcy). Visual analog scale (VAS) scores, kyphotic angles, anterior-border heights and diameters of the spinal canal of the fractured vertebrae, any incident of new OVCFs (onset of OVCF during follow-up), spine bone mineral density (BMD), and serum markers of bone resorption and bone formation were also examined at baseline and 1, 3, 6, and 12 months after initiation of the medication regimen.Results
At 12 months, mean mJOA score had improved in the teriparatide group and decreased in the alendronate group. Mean concentrations of bone formation and bone resorption biomarkers, mean spine BMD, and mean anterior-border height and spinal canal diameter of the fractured vertebrae were significantly greater in the teriparatide group than in the alendronate group. Mean VAS score, mean kyphotic angle of the fractured vertebrae, and incidence of new OVCFs were significantly smaller in the teriparatide group than in the alendronate group.Conclusions
In patients with neurological deficits following new unstable OVCF and with surgical contraindications, teriparatide was better than alendronate at improving the BMD and the bone turnover parameters, as well as preventing aggravation of spinal cord compromise.8.
Nicholas J. Goel Prateek Agarwal Arka N. Mallela Kalil G. Abdullah Zarina S. Ali Ali K. Ozturk Neil R. Malhotra James M. Schuster H. Isaac Chen 《The spine journal》2019,19(3):448-460
BACKGROUND AND CONTEXT
The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data are available about the importance of liver disease in spinal surgery.PURPOSE
To measure the independent impact of underlying liver disease on 30-day outcomes following surgery for the degenerative cervical spine.STUDY DESIGN
Retrospective comparative study.PATIENT SAMPLE
A cohort of 21,207 patients undergoing elective surgery for degenerative disease of the cervical spine from the American College of Surgeons National Surgical Quality Improvement Program.OUTCOME MEASURES
Outcome measures included mortality, hospital length of stay, and postoperative complications within 30 days of surgery.METHODS
The NSQIP dataset was queried for patients undergoing surgery for degenerative disease of the cervical spine from 2006 to 2015. Assessment of underlying liver disease was based on aspartate aminotransferase-to-platelet ratio index and Model of End-Stage Liver Disease-Sodium scores, computed from preoperative laboratory data. The effect of liver disease on outcomes was assessed by bivariate and multivariate analyses, in comparison with 16 other preoperative and operative factors.RESULTS
Liver disease could be assessed in 21,207 patients based on preoperative laboratory values. Mild liver disease was identified in 2.2% of patients, and advanced liver disease was identified in 1.6% of patients. The 30-day mortality rates were 1.7% and 5.1% in mild and advanced liver diseases, respectively, compared with 0.6% in patients with healthy livers. The 30-day complication rates were 11.8% and 31.5% in these patients, respectively, compared with 8.8% in patients with healthy livers. In multivariate analysis, the presence of any liver disease (mild or advanced) was independently associated with an increased risk of mortality (OR=2.00, 95% CI=1.12–3.55, p=.019), morbidity (OR=1.35, 95% CI=1.07–1.70, p=.012), and length of hospital stay longer than 7 days (OR=1.73, 95% CI=1.40–2.13, p<.001), when compared with 18 other preoperative and operative factors. Liver disease was also independently associated with perioperative respiratory failure (OR=1.80, 95% CI=1.21–2.68, p=.004), bleeding requiring transfusion (OR=1.43, 95% CI=1.01–2.02, p=.044), wound disruption (OR=2.82, 95% CI=1.04–7.66, p=.042), and unplanned reoperation (OR=1.49, 95% CI=1.05–2.11, p=.025).Conclusions
Liver disease independently predicts poor perioperative outcome following surgery for degenerative disease of the cervical spine. Based on these findings, careful consideration of a patient's underlying liver function before surgery may prove valuable in surgical decision-making, preoperative patient counseling, and postoperative patient care. 相似文献9.
Alexander M. Lieber Gregory J. Kirchner Yehuda E. Kerbel Amrit S. Khalsa 《The spine journal》2019,19(2):212-217
BACKGROUND CONTEXT
Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear.PURPOSE
This study aimed to compare rates of perioperative complications between robotic-assisted and conventional lumbar spinal fusion.STUDY DESIGN/SETTING
Retrospective cohort study.PATIENT SAMPLE
A total of 520 patients undergoing lumbar fusion were analyzed. The average ages of patients in the robotic-assisted versus conventional groups were 60.33 and 60.31, respectively (p=.987). Patients with a diagnosis of fracture, traumatic spinal cord injury, spina bifida, neoplasia, or infection were excluded.OUTCOME MEASURES
This study compared the rates perioperative major and minor complications for elective lumbar fusion between each cohort.METHODS
This study screened hospital discharges in the United States from 2010 to 2014 using the National Inpatient Sample and the Nationwide Inpatient Sample (NIS). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 209,073 patients who underwent conventional lumbar fusion (ICD 81.04-8) and 279 patients who underwent robotic-assisted lumbar fusion (ICD 81.04-8 and ICD 17.41, 17.49). Major and minor complications were identified using ICD-9-CM diagnosis codes. The robotic-assisted and conventional fusion groups were statistically matched on age, year, sex, indication, race, hospital type, and comorbidities. Univariate and multivariate logistic regression were used to compare risks of major and minor complications.RESULTS
We matched 257 (92.11%) robotic-assisted patients with an equal number of patients undergoing conventional lumbar fusion. Minor complications occurred in 16.73% of cases in the conventional group and 31.91% of cases in the robotic-assisted group (p<.001). Major complications occurred in 6.61% of the conventional cases compared to 8.17% of robotic-assisted cases (p=.533). For robotic-assisted fusion, multivariate analysis revealed that there was no difference in the likelihood of major complications (OR=0.834, 95% CI=0.214–3.251) or minor complications (OR?=?1.450, 95% CI=0.653–3.220).CONCLUSIONS
In a statistically matched cohort, patients who underwent robotic-assisted lumbar fusion had similar rates of major and minor complications compared to patients who underwent conventional lumbar fusion. 相似文献10.
11.
Philippe Phan Brandon Budhram Qiong Zhang Carly S. Rivers Vanessa K. Noonan Tova Plashkes Eugene K. Wai Jérôme Paquet Darren M. Roffey Eve Tsai Nader Fallah 《The spine journal》2019,19(4):703-710
BACKGROUND CONTEXT
Models for predicting recovery in traumatic spinal cord injury (tSCI) patients have been developed to optimize care. Several models predicting tSCI recovery have been previously validated, yet recent findings question their accuracy, particularly in patients whose prognoses are the least predictable.PURPOSE
To compare independent ambulatory outcomes in AIS (ASIA [American Spinal Injury Association] Impairment Scale) A, B, C, and D patients, as well as in AIS B+C and AIS A+D patients by applying two existing logistic regression prediction models.STUDY DESIGN
A prospective cohort study.PARTICIPANT SAMPLE
Individuals with tSCI enrolled in the pan-Canadian Rick Hansen SCI Registry (RHSCIR) between 2004 and 2016 with complete neurologic examination and Functional Independence Measure (FIM) outcome data.OUTCOME MEASURES
The FIM locomotor score was used to assess independent walking ability at 1-year follow-up.METHODS
Two validated prediction models were evaluated for their ability to predict walking 1-year postinjury. Relative prognostic performance was compared with the area under the receiver operating curve (AUC).RESULTS
In total, 675 tSCI patients were identified for analysis. In model 1, predictive accuracies for 675 AIS A, B, C, and D patients as measured by AUC were 0.730 (95% confidence interval [CI] 0.622–0.838), 0.691 (0.533–0.849), 0.850 (0.771–0.928), and 0.516 (0.320–0.711), respectively. In 160 AIS B+C patients, model 1 generated an AUC of 0.833 (95% CI 0.771–0.895), whereas model 2 generated an AUC of 0.821 (95% CI 0.754–0.887). The AUC for 515 AIS A+D patients was 0.954 (95% CI 0.933–0.975) with model 1 and 0.950 (0.928–0.971) with model 2. The difference in prediction accuracy between the AIS B+C cohort and the AIS A+D cohort was statistically significant using both models (p=.00034; p=.00038). The models were not statistically different in individual or subgroup analyses.CONCLUSIONS
Previously tested prediction models demonstrated a lower predictive accuracy for AIS B+C than AIS A+D patients. These models were unable to effectively prognosticate AIS A+D patients separately; a failure that was masked when amalgamating the two patient populations. This suggests that former prediction models achieved strong prognostic accuracy by combining AIS classifications coupled with a disproportionately high proportion of AIS A+D patients. 相似文献12.
Joshua A. Hirsch Douglas P. Beall M. Renée Chambers Thomas G. Andreshak Allan L. Brook Brian M. Bruel H. Gordon Deen Peter C. Gerszten D. Scott Kreiner Charles A. Sansur Sean M. Tutton Peter van der Meer Herman J. Stoevelaar 《The spine journal》2018,18(11):2152-2161
BACKGROUND CONTEXT
Vertebral fragility fractures (VFFs), mostly due to osteoporosis, are very common and are associated with significant morbidity and mortality. There is a lack of consensus on the appropriate management of patients with or suspected of having a VFF.PURPOSE
This work aimed at developing a comprehensive clinical care pathway (CCP) for VFF.STUDY DESIGN/SETTING
The RAND/UCLA Appropriateness Method was used to develop patient-specific recommendations for the various components of the CCP. The study included two individual rating rounds and two plenary discussion sessions.METHODS
A multispecialty expert panel (orthopedic and neurosurgeons, interventional [neuro]radiologists and pain specialists) assessed the importance of 20 signs and symptoms for the suspicion of VFF, the relevance of 5 diagnostic procedures, the appropriateness of vertebral augmentation versus nonsurgical management for 576 clinical scenarios, and the adequacy of 6 aspects of follow-up care.RESULTS
The panel identified 10 signs and symptoms believed to be relatively specific for VFF. In patients suspected of VFF, advanced imaging was considered highly desirable, with MRI being the preferred diagnostic modality. Vertebral augmentation was considered appropriate in patients with positive findings on advanced imaging and in whom symptoms had worsened and in patients with 2 to 4 unfavorable conditions (eg, progression of height loss and severe impact on functioning), dependent on their relative weight. Time since fracture was considered less relevant for treatment choice. Follow-up should include evaluation of bone mineral density and treatment of osteoporosis.CONCLUSIONS
Using the RAND/UCLA Appropriateness Method, a multispecialty expert panel established a comprehensive CCP for the management of VFF. The CCP may be helpful to support decision-making in daily clinical practice and to improve quality of care. 相似文献13.
Carlo Ammendolia Y. Raja Rampersaud Danielle Southerst Aksa Ahmed Michael Schneider Gillian Hawker Claire Bombardier Pierre Côté 《The spine journal》2019,19(3):386-394
BACKGROUND CONTEXT
Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking.PURPOSE
The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS.STUDY DESIGN
This was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLE
We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURES
The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals.METHODS
Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years).RESULTS
Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was ?74 m (95% CI: ?282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5–1.3, p=.43).CONCLUSIONS
A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. 相似文献14.
Alexander Tuchman Lawrence G. Lenke Meghan Cerpa Michael G. Fehlings Stephen J. Lewis Christopher I. Shaffrey Kenneth M.C. Cheung Leah Yacat Carreon Mark B. Dekutoski Frank J. Schwab Oheneba Boachie-Adjei Khaled Kebaish Christopher P. Ames Yong Qiu Yukihiro Matsuyama Benny T. Dahl Hossein Mehdian Ferran Pellisé Sigurd H. Berven 《The spine journal》2019,19(3):395-402
BACKGROUND CONTEXT
Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population.PURPOSE
To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits.STUDY DESIGN
Secondary analysis of a prospective, multicenter, international cohort study.METHODS
In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed.RESULTS
A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR ?1.0 to 0.0; bilateral 0.0, IQR ?1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively.CONCLUSIONS
The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery. 相似文献15.
Denise Lee Marcella D. Walker Hsin Yi Chen John A. Chabot James A. Lee Jennifer H. Kuo 《Surgery》2019,165(1):107-113
Background
Bone mineral density (BMD) has been found to improve after parathyroidectomy (PTX) in patients with primary hyperparathyroidism. There are few data on the effect of PTX on BMD in normocalcemic and normohormonal primary hyperparathyroidism.Methods
A retrospective analysis of 92 primary hyperparathyroidism patients who underwent PTX between 2004 and 2012 with pre- and post-PTX dual-energy x-ray absorptiometry was performed. Within-person changes in BMD pre- and post-PTX were analyzed using log linear mixed models, stratified by biochemical status.Results
Bone mineral density increased post-PTX in the whole cohort at the lumbar spine (+2.5%), femoral neck (+2.1%), and total hip (+1.9%) and decreased at the one-third radius (–0.9%). On comparison of BMD changes by profile, BMD increased in those with the typical profile at the lumbar spine (3.2%), femoral neck (2.9%), and total hip (2.9%) but declined at the one-third radius (–1.5%). In contrast, BMD improved only at the femoral neck (4.3%) in the normohormonal group and did not change at any site in the normocalcemic group. The typical group had a greater increase in BMD over time at the femoral neck and total hip compared with normocalcemic patients.Conclusion
Our results indicate that the skeletal benefit of PTX was attenuated in normocalcemic and normohormonal patients, suggesting that skeletal changes after PTX may depend on biochemical profile. 相似文献16.
Juan A. Sanchis-Gimeno Susanna Llido Marcelino Perez-Bermejo Shahed Nalla 《The spine journal》2018,18(11):2102-2111
BACKGROUND CONTEXT
The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed.PURPOSE
To analyze the prevalence of the AF, RTF, UTF, and PAAD.STUDY DESIGN
Ex-vivo anatomical study.PATIENT SAMPLE
Two hundred eighteen atlas vertebrae obtained from 100 Caucasian subjects and 118 sub-Saharan African subjects (48 Sotho subjects, 35 Xhosa subjects and 35 Zulu subjects).METHODS
We studied 218 atlas vertebrae from skeletons of the Raymond A. Dart Collection in order to analyze the prevalence of AF, RTF, UTF, and PAAD in both Caucasian and sub-Saharan African subjects.OUTCOME MEASURES
Not applicable.RESULTS
Sixty-nine (31.2%) atlases presented anatomical variants: 64 (29.3%) presented one anatomical variant, 4 (1.8%) presented two, and 1 (0.5%) presented three. AF, RTF, UTF, Type A and Type E defects were present in 35 (16.1%), 17 (7.8%), 17 (7.8%), 5 (2.3%), and 1 (0.5%) vertebrae, respectively. The vertebrae with two anatomical variants presented a bilateral UTF and a Type A defect, a bilateral AF and a Type A defect, a right UTF and a left AF, and a right UTF and a Type E defect. The vertebra with three anatomical variants presented a bilateral RTF, a left UTF, and a left AF. No sex differences in prevalence of the RTF (p=.775), AF (p=.605), UTF (p=.408) and Type A defects (p=1.000) were found in the sub-Saharan African and Caucasian groups (RTF, p=.306; AF, p=.346; UTF, p=.121; Type A defects, p=.561). Comparison between the sub-Saharan African (all subjects) and the Caucasian group revealed no differences in the UTF (p=.105), AF (p=.144), RTF (p=.542) and Type A defects (p=.521) prevalence. Also, no differences in the prevalence of the UTF (p=.515), AF (p=.278), and RTF (p=.857) between Zulu, Xhosa and Sotho subjects were found. Neither were found sex differences in the prevalence of UTF, RTF and AF in Zulu (p=.805, p=.234, p=.129), Xhosa (p=.269, p=.181, p=.309), and Sotho subjects (p=.062, p=.590, p=.106).CONCLUSIONS
The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning. 相似文献17.
Selective blocking laminoplasty in cervical laminectomy and fusion to prevent postoperative C5 palsy
BACKGROUND CONTEXT
Cervical laminectomy and fusion (CLF) is a common surgical option for multilevel cord compression. Postoperative C5 palsy occurrence after CLF has been a vexing problem for spine physicians. The posterior shift of the cord following laminectomy has been implicated as a major factor for postoperative C5 palsy, but attempts by spine surgeons to mitigate excessive shift while providing sufficient decompression have not been well reported.PURPOSE
To compare the incidence of postoperative C5 palsy after performing selective blocking laminoplasty concurrently with CLF to those of conventional CLF.STUDY DESIGN
A retrospective comparative study of prospectively collected data.PATIENT SAMPLE
Of 116 cervical myelopathy patients with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, and multilevel disc herniation, 93 patients (69 in group A [CLF group] and 24 in group B [selective blocking laminoplasty with CLF, CLF-S group]) were included in the study.OUTCOME MEASURES
The primary outcome measure was the occurrence of postoperative C5 palsy. Secondary end points included (1) clinical outcomes based on pain intensity, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, (2) radiologic outcomes including cervical alignment and fusion rate at 1 year and hardware complications, and (3) perioperative data (hospital stay, blood loss, and operative times).METHODS
We compared the occurrence of postoperative C5 palsy, as well as clinical, radiologic, and surgical outcomes, between the two groups at 1-year follow-up.RESULTS
The patients in both groups were statistically similar between the groups with respect to demographic characteristics such as age, sex, smoking status, body mass index, preoperative pathology, surgical segments, and the degree of the cervical lordosis. Postoperative C5 palsy developed in 9 of 61 patients (14%) in group A and in 0 of 24 patients (0%) in group B (CLF-S group) (p=.03). Postoperative neck pain, NDI, and JOA improvement were not significantly different between the two groups (p=.93, 0.90, and 0.79, respectively). Perioperative data did not differ significantly between the two groups.CONCLUSIONS
This study showed that performing selective blocking laminoplasty might lead to reducing the incidence of postoperative C5 palsy in CLF surgery. 相似文献18.
P. Endler P. Ekman H. Ljungqvist T.B. Brismar P. Gerdhem H. Möller 《The spine journal》2019,19(3):501-508
BACKGROUND CONTEXT
Data on the long-term outcome after fusion for isthmic spondylolisthesis are scarce.PURPOSE
To study patient-reported outcomes and adjacent segment degeneration (ASD) after fusion for isthmic spondylolisthesis and to compare patient-reported outcomes with a control group.STUDY DESIGN/SETTING
A prospective study including a cross-sectional control group.PATIENT SAMPLE
Patients with isthmic spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) (n=86) or posterolateral fusion (PLF) (n=77). Patient-reported outcome data were available for 73 patients in the PLIF group and 71 in the PLF group at a mean of 11 (range 5–16) years after baseline. Seventy-seven patients in the PLIF group and 54 in the PLF group had radiographs at a mean of 14 (range 9–19) years after baseline. One hundred thirty-six randomly selected persons from the population served as controls for the patient-reported outcomes.OUTCOME MEASURES
Patient-reported outcomes include the following: global outcome, Oswestry Disability Index, Disability Rating Index, and Short Form 36. The ASD was determined from radiographs using the University of California Los Angeles (UCLA) grading scale.METHODS
: The chi-square test or analysis of covariance (ANCOVA) was used for group comparisons. The ANCOVA was adjusted for follow-up time, smoking, Meyerding slippage grade, teetotaler (yes/no) and, if available, the baseline level of the dependent variable.RESULTS
There were no significant patient-reported outcome differences between the PLIF group and the PLF group. The prevalence of ASD was 42% (32/77) in the PLIF group and 26% (14/54) in the PLF group (p=.98). The patient-reported outcome data indicated lower physical function and more pain in individuals with surgically treated isthmic spondylolisthesis compared to the controls.CONCLUSIONS
PLIF and PLF groups had similar long-term patient-reported and radiological outcomes. Individuals with isthmic spondylolisthesis have lower physical function and more pain several years after surgery when compared to the general population. 相似文献19.
Micheal Raad Amit Jain Mitchell Huang Richard L. Skolasky Daniel M. Sciubba Khaled M. Kebaish Brian J. Neuman 《The spine journal》2019,19(1):50-55
BACKGROUND CONTEXT
Validity and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) have been investigated in several orthopaedic subspecialties. PROMIS has shorter completion time and greater research flexibility for the heterogeneous adult spinal deformity (ASD) population versus the Oswestry Disability Index (ODI) and Scoliosis Research Society 22-item questionnaire (SRS-22r).PURPOSE
Evaluate the validity and responsiveness of PROMIS in ASD surgery, during the early postoperative period.DESIGN
Prospective, longitudinal study.PATIENT SAMPLE
One hundred twenty-three patients with complete SRS-22r and PROMIS data.OUTCOME MEASURES
Validity and responsiveness of PROMIS versus the ODI and SRS-22r.METHODS
We identified patients who completed SRS-22r, ODI, and PROMIS questionnaires. Spearman's correlation was used to assess validity, paired-samples t tests to assess responsiveness, and Cohen's d to assess measure of effect. The authors report no conflicts of interests. No funding was received in support of this study.RESULTS
One hundred twenty-three patients with SRS-22r and PROMIS data from the preoperative visit were included in the validity analysis. Seventy-six patients with preoperative and early postoperative (6-week to 3-month) data were included in the responsiveness analysis. The SRS-22r function, self-image, pain, and mental health scores were moderately to strongly correlated with the following PROMIS domains: physical function (r?=?0.53), satisfaction with participation in social roles (r?=?0.51), pain (r?=??0.60), and anxiety (r?=??0.73). All SRS-22r domains, PROMIS domains, and ODI scores changed significantly from preoperatively to postoperatively (p < 0.05). Compared with the SRS-22r, PROMIS showed superior responsiveness across all domains except self-image.CONCLUSIONS
Our results indicate that PROMIS is a valid measure with comparable responsiveness to that of the SRS-22r and ODI during the early period after ASD surgery. However, a domain that reflects how ASD patients perceive their self-image should be developed and validated. 相似文献20.
Shaan A. Ahmed Govind Shantharam Adam E.M. Eltorai Davis A. Hartnett Avi Goodman Alan H. Daniels 《The spine journal》2019,19(2):232-237