共查询到20条相似文献，搜索用时 15 毫秒
1.
Sabina R. Blizzard Bala Krishnamoorthy Matthew Shinseki Marcel Betsch Jung Yoo 《The spine journal》2017,17(12):1859-1865
Background Context
Although it is generally believed that the magnitude of dens fracture displacement is proportional to the amount of force applied to the cervical spine during injury, the factors responsible for displacement have not been studied.Purpose
Our aim was to determine factors that contribute to horizontal and angular displacement of dens fractures.Study Design/Setting
We conducted a retrospective review of adult patients who were admitted to our level 1 trauma center between January 1, 2008 and December 31, 2013.Patient Sample
Angular and horizontal displacements of the fractured dens in 57 patients were measured. Subjects were grouped based on mechanism of fracture: motor vehicle accident, ground level fall, and higher falls.Outcome Measures
Cervical lordosis was measured between C2 and T1. C3–C4, C4–C5, C5–C6, and C6–C7 disc inclination angles were measured. Anteroposterior sagittal balance was assessed by comparing the sagittal position of the C2 body with the C7 body.Methods
Data were analyzed using Pearson correlations, independent t tests, and support vector regression to construct predictive models that determine factors contributing to the angular and horizontal displacements.Results
The mean horizontal displacement of the fractured dens was not significantly different among groups. However, the dens in those with ground level falls had a significantly greater mean fracture angle compared with the higher energy trauma groups (p=.01). There were positive correlations between angular displacement and C5–C6 disc space inclination angle (r=0.67, p<.01) and C6–C7 disc space inclination angle (r=0.61, p<.01). There were positive correlations between horizontal displacement and C6–C7 inclination angle (r=0.40, p<.01) and sagittal alignment (r=0.32, p<.01). The predictive model using all variables demonstrated that angular fracture displacement was only dependent on C5–C6 disc space inclination angle. Horizontal displacement was only dependent on C6–C7 inclination angle and anteroposterior sagittal balance.Conclusions
Disc space inclination angles of the lower cervical spine and the cervical sagittal balance most contribute to the magnitude of angular and horizontal displacement of the dens after fracture. 相似文献2.
Ehsan Jazini Tristan Weir Emeka Nwodim Oliver Tannous Comron Saifi Nicholas Caffes Timothy Costales Eugene Koh Kelley Banagan Daniel Gelb Steven C. Ludwig 《The spine journal》2017,17(9):1238-1246
Background Context
Complex sacral fractures with vertical and anterior pelvic ring instability treated with traditional fixation methods are associated with high rates of failure and poor clinical outcomes. Supplemental lumbopelvic fixation (LPF) has been applied for additional stability to help with fracture union.Purpose
The study aimed to determine whether minimally invasive LPF provides reliable fracture stability and acceptable complication rates in cases of complex sacral fractures.Study Design/Setting
This is a retrospective cohort study at a single level I trauma center.Patient Sample
The sample includes 24 patients who underwent minimally invasive LPF for complex sacral fracture with or without associated pelvic ring injury.Outcome Measures
Reoperation for all causes, loss of fixation, surgical time, transfusion requirements, length of hospital stay, postoperative day at mobilization, and mortality were evaluated.Methods
Patient charts from 2008 to 2014 were reviewed. Of the 32 patients who underwent minimally invasive LPF for complex sacral fractures, 24 (12 male, 12 female) met all inclusion and exclusion criteria. Outcome measures were assessed with a retrospective chart review and radiographic review. The authors did not receive external funding for this study.Results
Acute reoperation was 12%, and elective reoperation was 29%. Two (8%) patients returned to the operating room for infection, one (4.2%) required revision for instrumentation malposition, and seven (29%) underwent elective removal of instrumentation. No patient experienced failure of instrumentation or loss of correction. Average surgical time was 3.6 hours, blood loss was 180?mL, transfusion requirement was 2.1 units of packed red blood cells, and postoperative mobilization was on postoperative day 5. No mortalities occurred as a result of the minimally invasive LPF procedure.Conclusions
Compared with historic reports of open LPF, our results demonstrate reliable maintenance of reduction and acceptable complication rates with minimally invasive LPF for complexsacral fractures. The benefits of minimally invasive LPF may be offset with increased elective reoperations for removal of instrumentation. 相似文献3.
Fady Y. Hijji Ankur S. Narain Daniel D. Bohl Junyoung Ahn William W. Long Jacob V. DiBattista Krishna T. Kudaravalli Kern Singh 《The spine journal》2017,17(10):1412-1419
Background Context
Lateral lumbar interbody fusion (LLIF) is a frequently used technique for the treatment of lumbar pathology. Despite its overall success, LLIF has been associated with a unique set of complications. However, there has been inconsistent evidence regarding the complication rate of this approach.Purpose
To perform a systematic review analyzing the rates of medical and surgical complications associated with LLIF.Study Design
Systematic review.Patient Sample
6,819 patients who underwent LLIF reported in clinical studies through June 2016.Outcome Measures
Frequency of complications within cardiac, vascular, pulmonary, urologic, gastrointestinal, transient neurologic, persistent neurologic, and spine (MSK) categories.Methods
This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies that identified rates of any complication following LLIF procedures were obtained from PubMed, MEDLINE, and EMBASE databases. Articles were excluded if they did not report complications, presented mixed complication data from other procedures, or were characterized as single case reports, reviews, or case series containing less than 10 patients. The primary outcome was frequency of complications within cardiac, vascular, pulmonary, urologic, gastrointestinal, transient neurologic, persistent neurologic, and MSK categories. All rates of complications were based on the sample sizes of studies that mentioned the respective complications. The authors report no conflicts of interest directly or indirectly related to this work, and have not received any funds in support of this work.Results
A total of 2,232 articles were identified. Following screening of title, abstract, and full-text availability, 63 articles were included in the review. A total of 6,819 patients had 11,325 levels fused. The rate of complications for the categories included were as follows: wound (1.38%; 95% confidence interval [CI]=1.00%–1.85%), cardiac (1.86%; CI=1.33%–2.52%), vascular (0.81%; CI=0.44%–1.36%), pulmonary (1.47; CI=0.95%–2.16%), gastrointestinal (1.38%; CI=1.00%–1.87%), urologic (0.93%; CI=0.55%–1.47%), transient neurologic (36.07%; CI=34.74%–37.41%), persistent neurologic (3.98%; CI=3.42%–4.60%), and MSK or spine (9.22%; CI=8.28%–10.23%).Conclusions
The current study is the first to comprehensively analyze the complication profile for LLIFs. The most significant reported complications were transient neurologic in nature. However, persistent neurologic complications occurred at a much lower rate, bringing into question the significance of transient symptoms beyond the immediate postoperative period. Through this analysis of complication profiles, surgeons can better understand the risks to and expectations for patients following LLIF procedures. 相似文献4.
Insa Janssen Yu-Mi Ryang Jens Gempt Stefanie Bette Julia Gerhardt Jan S. Kirschke Bernhard Meyer 《The spine journal》2017,17(6):837-844
Background
Cement-augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine is indicated in osteoporosis or osteopenia to improve pullout strength and biomechanical stability of pedicle screws (PS). Only a few studies report on the incidence of pulmonary cement embolism or other complications associated with CAPSI.Purpose
The aim of this retrospective study was to assess the rate of CAPSI-associated complications.Study Design
Retrospective cohort study.Patient Sample
Patients who underwent CAPSI due to spinal tumors or degenerative spine disease.Outcome Measures
Cement leakage, pulmonary cement embolism (PCE), mortality rate.Methods
Our clinical database was reviewed for patients who underwent CAPSI between January 2012 and June 2015. A total of 165 patients (mean age 71±11.2; range: 46 to 93 years; m=62, f=103) were included. Indications were osteoporotic fractures (n=40), spinal metastases (n=57), degenerative (n=49) or infectious spine disease (n=5), and traumatic vertebral fractures (n=14) with an associated osteoporosis. Every patient received between 2 and 21 (mean 8±3.3) cement-augmented pedicle screws in the thoracolumbar and lumbosacral spine. Both intraoperative cement leakage in prevertebral veins, the inferior vena cava, and/or pulmonary arteries, and leakage detected on postoperative imaging were evaluated. We assessed the incidence of clinically symptomatic and asymptomatic events.Results
In 29 of 31 patients with intraoperative suspicion of cement leakage into prevertebral veins or the inferior vena cava on lateral fluoroscopy, which were without hemodynamic relevance, cement extrusion was confirmed on postoperative X-ray or computed tomography (CT) scan. In three of eight patients with suspicion of PCE, PCE was verified on thoracic CT. Four patients experienced life-threatening intraoperative hemodynamic reactions, either due to cement embolism (n=2; 1.2%) or anaphylactic shock (n=2; 1.2%) with need for intraoperative cardiopulmonary resuscitation in three cases. Two patients died due to fulminant PCE. Three patients with dyspnea 1 day after surgery were also confirmed with PCE on chest CT. In five patients, an asymptomatic PCE was found incidentally on postoperative imaging. In addition, 68 patients with cement leakage into prevertebral veins or the ascending cava vein were found incidentally on postoperative spine X-ray or CT. Two of 10 patients with intraspinal epidural cement leakage required revision surgery. One hundred ten of 165 patients (66.7%) had clinically asymptomatic cement leakage. Thirteen patients had PCE (7.9%), of whom five (3.0%) were symptomatic. Two patients experienced intraoperative cement-induced anaphylaxis (1.2%). The overall symptomatic complication rate was 5.5% (n=9). The 30-day mortality rate was 1.8% (n=3).Conclusions
CAPSI bears a high risk of asymptomatic cement leakage. The risk for associated severe complications was also relatively high and probably underestimated considering the retrospective nature of the present study. A strict indication for cement augmentation, especially in patients with cardiac predisposition, should be the consequence. We doubt that technical aspects of cement application and/or different types of cement are capable of reducing the risk of these complications substantially. 相似文献5.
Background Context
Short-term readmission rates are becoming widely used as a quality and performance metric for hospitals. Data on unplanned short-term readmission after spine fusion for deformity in pediatric patients are limited.Purpose
To characterize the rate and risk factors for short-term readmission after spine fusion for deformity in pediatric patients.Study Design
This is a retrospective cohort study.Patient Sample
Data were obtained from the State Inpatient Database from New York, Utah, Nebraska, Florida, North Carolina (years 2006–2010), and California (years 2006–2011).Outcome Measures
Outcome measures included 30- and 90-day readmission rates.Materials and Methods
Inclusion criteria were patients aged 0–21 years, a primary diagnosis of spine deformity, and a primary 3+-level lumbar or thoracic fusion. Exclusion criteria included revision surgery at index admission and cervical fusion. Readmission rates were calculated and logistic analyses were used to identify independent predictors of readmission.Results
There were a total of 13,287 patients with a median age of 14 years. Sixty-seven percent were girls. The overall 30- and 90-day readmission rates were 4.7% and 6.1%. The most common reasons for readmission were infection (38% at 30 days and 33% at 90 days), wound dehiscence (19% and 17%), and pulmonary complications (12% and 13%). On multivariate analysis, predictors of 30-day readmission included male sex (p=.008), neuromuscular (p<.0001) or congenital scoliosis (p=.006), Scheuermann kyphosis (p=.003), Medicaid insurance (p<.0001), length of stay of ≤3 days or ≥6 days (p<.0001), and surgery at a teaching hospital (p=.011). Surgery at a hospital performing >80 operations/year was associated with a 34% reduced risk of 30-day readmission (95% confidence interval 12%-50%, p=.005) compared with hospitals performing <20 operations/year.Conclusions
The short-term readmission rate for pediatric spine deformity surgery is driven by patient-related factors, as well as several risk factors that may be modified to reduce this rate. 相似文献6.
Background Context
The oblique lateral interbody fusion (OLIF) procedure is aimed at mitigating some of the challenges seen with traditional anterior lumbar interbody fusion (ALIF) and transpsoas lateral lumbar interbody fusion (LLIF), and allows for interbody fusion at L1–S1.Purpose
The study aimed to describe the OLIF technique and assess the complication and fusion rates.Study Design
This is a retrospective cohort study.Patient Sample
The sample is composed of 137 patients who underwent OLIF procedure.Outcome Measures
The outcome measures were adverse events within 6 months of surgery: infection, symptomatic pseudarthrosis, hardware failure, vascular injury, perioperative blood transfusion, ureteral injury, bowel injury, renal injury, prolonged postoperative ileus (more than 3 days), incisional hernia, pseudohernia, reoperation, neurologic deficits (weakness, numbness, paresthesia), hip flexion pain, retrograde ejaculation, sympathectomy affecting lower extremities, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, and cerebrovascular accident. The outcome measures also include fusion and subsidence rates based on computed tomography (CT) done at 6 months postoperatively.Methods
Retrospective chart review of 150 consecutive patients was performed to examine the complications associated with OLIF at L1–L5 (OLIF25), OLIF at L5–S1 (OLIF51), and OLIF at L1–L5 combined with OLIF at L5–S1 (OLIF25+OLIF51). Only patients who had at least 6 months of postoperative follow-up, including CT scan at 6 months after surgery, were included. Independent radiology review of CT data was performed to assess fusion and subsidence rates at 6 months.Results
A total of 137 patients underwent fusion at 340 levels. An overall complication rate of 11.7% was seen. The most common complications were subsidence (4.4%), postoperative ileus (2.9%), and vascular injury (2.9%). Ileus and vascular injuries were only seen in cases including OLIF51. No patient suffered neurologic injury. No cases of ureteral injury, sympathectomy affecting the lower extremities, or visceral injury were seen. Successful fusion was seen at 97.9% of surgical levels.Conclusions
Oblique lateral interbody fusion is a safe procedure at L1–L5 as well as L5–S1. The complication profile appears acceptable when compared with LLIF and ALIF. The oblique trajectory mitigates psoas muscle and lumbosacral plexus-related complications seen with the lateral transpsoas approach. Furthermore, there is a high fusion rate based on CT data at 6 months. 相似文献7.
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
Background Context
To date, no information about the cortical bone microstructural properties in atlas vertebrae with posterior arch defects has been reported.Purpose
To test if there is an increased cortical bone thickening in atlases with Type A posterior atlas arch defects in an experimental model.Study Design
Micro-computed tomography (CT) study on cadaveric atlas vertebrae.Methods
We analyzed the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry vertebrae with a Type A atlas arch defect and normal control vertebrae.Results
The micro-CT study revealed significant differences in cortical bone thickness (p=.005), cortical volume (p=.003), and medullary volume (p=.009) values between the normal and the Type A vertebrae.Conclusions
Type A congenital atlas arch defects present a cortical bone thickening that may play a protective role against atlas fractures. 相似文献8.
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9.
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.
Zhiwei Yang Fang Xie Jianxin Zhang Zhuowen Liang Zhe Wang Xueyu Hu Zhuojing Luo 《The spine journal》2017,17(12):1812-1818
Background Context
The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures on the difference and correlation of the sagittal parameters between the two shooting positions.Purpose
The study aimed to investigate the difference of sagittal parameters in spine lateral radiographs between latericumbent and upright positions, identify the correlation, and establish a preliminary linear fitting formula.Study Design
The study is a prospective study on radiographic evaluation of sagittal alignment using latericumbent and upright positions.Patient Sample
One hundred fifty-seven patients were recruited from the orthopedics clinic of a single medical center.Outcome Measure
Angle measurement, the intra- and interobserver measurement reliability of measurement, and analysis of the angle measurement were carried out.Method
The sagittal alignment of 157 patients were assessed using Surgimap software from two kinds of lateral radiographs to acquire the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L4–L5 intervertebral angle (IVA4–5), L4–L5 intervertebral height index (IHI4–5), and PI–LL. The Kolmogorov-Smirnov test, paired t test, Pearson correlation analysis, and multivariate linear regression analysis were used to analyze the data.Results
The results showed significantly statistical difference in LL, SS, PT, IVA4–5, and PI–LL, except for PI and IHI4–5, between the two positions. There was a significant relativity between standing LL and latericumbent LL (r=0.733, p<.01), PI (r=0.611, p<.01), and SS (r=0.626, p<.01). The predictive formula of standing LL was 12.791+0.777 latericumbent LL+0.395 latericumbent PI?0.506 latericumbent SS (adjusted R2=0.619, p<.05).Conclusion
Not all of sagittal parameters obtained from two positions are identical. Thus, the full-spine lateral standing films are difficult to be replaced. The surgeon should give sufficient consideration to the difference between the two views. We may primarily predict standing LL with the formula when we could not get whole-spine lateral standing radiographs. 相似文献12.
Jiann-Her Lin Li-Nien Chien Wan-Ling Tsai Li-Ying Chen Yung-Hsiao Chiang Yi-Chen Hsieh 《The spine journal》2017,17(9):1310-1318
Background Context
Whether early vertebroplasty (VP) (within 3 months) offers extra benefit to aged patients older than 70 years with painful vertebral compression fractures (PVCF) in terms of mortality and respiratory-related morbidity remains unknown, given that the elderly is associated with higher surgical risks.Purpose
To elucidate the benefits of an early VP intervention for aged patients with a PVCF by comparing the risks of mortality and respiratory-related morbidity.Study Design
A retrospective propensity score matched cohort.Patient Sample
PVCF patients with an early VP and without an early VP intervention.Outcome Measures
Death, pneumonia, and respiratory failure.Methods
A total of 10,785 PVCF patients who used analgesic injection during admission from 2000 through 2013 were selected from the National Health Insurance Research Database in Taiwan. After matching, there were 1773 VP patients and 5324 non-VP patients included in this study. Conditional Cox proportional hazard models were used to determine the risk of death and respiratory complications.Results
The incidences of death at 1 year of VP and non-VP patients were 0.46 (95% confidence interval [CI]: 0.38–0.56) and 0.63 (95% CI: 0.57–0.70) per 100 person-months, respectively. We observed a hazard ratio (HR) of 1.39 (95% CI: 1.09–1.78, p=.008) when comparing non-VP to VP patients. This phenomenon was seen when estimating the benefits of respiratory failure (HR: 1.46; 95% CI: 1.04–2.05, p=.028).Conclusion
The results showed that VP was associated with lower risks of mortality and respiratory failure in aged patients with a PVCF. VP should be considered a priority for the aged patients with a PVCF requiring admission and analgesics. 相似文献13.
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14.
Javier Z. Guzman Robert K. Merrill Jun S. Kim Samuel C. Overley James E. Dowdell Sulaiman Somani Andrew C. Hecht Samuel K. Cho Sheeraz A. Qureshi 《The spine journal》2017,17(9):1247-1254
Background Context
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been widely adopted as a fusion adjunct in spine surgery since its approval in 2002. A number of concerns regarding adverse effects and potentially devastating complications of rhBMP-2 use led to a Food and Drug Administration (FDA) advisory issued in 2008 cautioning its use, and a separate warning about its potential complications was published by The Spine Journal in 2011.Purpose
To compare trends of rhBMP-2 use in spine surgery after the FDA advisory in 2008 and The Spine Journal warning in 2011.Study Design
Retrospective cross-sectional study using a national database.Patient Sample
All patients from 2002 to 2013 who underwent spinal fusion surgery at an institution participating in the Nationwide Inpatient Sample (NIS).Outcome Measures
Proportion of spinal fusion surgeries using rhBMP-2.Methods
We queried the NIS from 2002 to 2013 and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes to identify spinal fusion procedures and those that used rhBMP-2. Procedures were subdivided into primary and revision fusions, and by region of the spine. Cervical and lumbosacral fusions were further stratified into anterior and posterior approaches. The percentage of cases using BMP was plotted across time. A linear regression was fit to the data from quarter 3 of 2008 (FDA advisory) through quarter 1 of 2011, and a separate regression was fit to the data from quarter 2 of 2011 (The Spine Journal warning) onward. The slopes of these regression lines were statistically compared to determine differences in trends. No funding was received to conduct this study, and no authors had any relevant conflicts of interest.Results
A total of 4,167,079 patients in the NIS underwent spinal fusion between 2002 and 2013. We found a greater decrease in rhBMP-2 use after The Spine Journal warning compared with the FDA advisory for all fusion procedures (p=.006), primary fusions (p=.006), and revision fusions (p=.004). Lumbosacral procedures also experienced a larger decline in rhBMP-2 use after The Spine Journal article as compared with the FDA warning (p=.0008). This pattern was observed for both anterior and posterior lumbosacral fusions (p≤.0001 for both). Anterior cervical fusion was the only procedure that demonstrated a decline in rhBMP-2 use after the FDA advisory that was statistically greater than after The Spine Journal article (p=.02).Conclusions
Warnings sanctioned through the spine literature may have a greater influence on practice of the spine surgery community as compared with advisories issued by the FDA.Comprehensive guidelines regarding safe and effective use of rhBMP-2 must be established. 相似文献15.
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16.
Meng-Huang Wu Navneet Kumar Dubey Yen-Yao Li Ching-Yu Lee Chin-Chang Cheng Chung-Sheng Shi Tsung-Jen Huang 《The spine journal》2017,17(8):1082-1090
Background Context
To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable.Purpose
This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis.Study Design
This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis.Patient Sample
One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited.Outcome Measures
The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation.Methods
All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed.Results
MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p<.01). Operation time was significantly lower in the MISS-iCT and OS groups compared with the MISS-FS group (p=.002). Postoperatively, VAS scores at 1 year and 2 years were significantly improved in the MISS-iCT and MISS-FS groups compared with the OS groups. No significant difference in the number of pedicle screw breach (>2?mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049).Conclusions
MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. 相似文献17.
Hideki Shigematsu Masahiko Kawaguchi Hironobu Hayashi Tsunenori Takatani Eiichiro Iwata Masato Tanaka Akinori Okuda Yasuhiko Morimoto Keisuke Masuda Yuu Tanaka Yasuhito Tanaka 《The spine journal》2017,17(10):1472-1479
Background Context
During spine surgery, the spinal cord is electrophysiologically monitored via transcranial electrical stimulation of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial electrical stimulation of motor-evoked potential involves the use of either constant-current or constant-voltage stimulation; however, there are few comparative data available regarding their ability to adequately elicit compound motor action potentials. We hypothesized that the success rates of TES-MEP recordings would be similar between constant-current and constant-voltage stimulations in patients undergoing spine surgery.Purpose
The objective of this study was to compare the success rates of TES-MEP recordings between constant-current and constant-voltage stimulation.Study Design
This is a prospective, within-subject study.Patient Sample
Data from 100 patients undergoing spinal surgery at the cervical, thoracic, or lumbar level were analyzed.Outcome Measures
The success rates of the TES-MEP recordings from each muscle were examined.Materials and Methods
Transcranial electrical stimulation with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions (international “10–20” system) was applied to each patient. Compound muscle action potentials were bilaterally recorded from the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH), tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles.Results
The success rates of the TES-MEP recordings from the right Del, right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles were significantly higher using constant-voltage stimulation than those using constant-current stimulation. The overall success rates with constant-voltage and constant-current stimulations were 86.3% and 68.8%, respectively (risk ratio 1.25 [95% confidence interval: 1.20–1.31]).Conclusions
The success rates of TES-MEP recordings were higher using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery. 相似文献18.
Cun-Xin Zhang Ting Wang Jin-Feng Ma Yang Liu Zheng-Gang Zhou De-Chun Wang 《The spine journal》2017,17(7):1017-1025
Background Context
Intervertebral disc degeneration (IDD) is the main cause of low back pain, and nucleus pulposus (NP) cell apoptosis is an important risk factor of IDD. However, the molecular mechanism of this disease remains unknown.Purpose
To assess the potential protective effect of CDDO-ethyl amide (EA) against high-glucose-induced oxidative stress injury in NP cells and to investigate the mechanism of antioxidative effects and apoptotic inhibition.Study Design/Setting
To find new molecule to inhibit intervertebral disc degeneration.Methods
Viability, reactive oxygen species (ROS) levels, and apoptosis were examined in NP cells. The protein expression levels of HO-1 and Nrf2 were measured through Western blotResults
CDDO-EA elicited cytoprotective effects against NP cell apoptosis and ROS accumulation induced by high glucose. CDDO-EA treatment increased the HO-1 and Nrf2 expression abrogated by HO-1, Nrf2, and mitogen-activated protein kinase inhibitors.Conclusions
The phosphorylation and nuclear translocation of Nrf2 are crucial for HO-1 overexpression induced by CDDO-EA, which is essential for the cytoprotection against high–glucose-induced oxidative stress in NP cells. 相似文献19.
Amer F. Samdani Steven W. Hwang Anuj Singla James T. Bennett Robert J. Ames Jeff S. Kimball 《The spine journal》2017,17(10):1406-1411
Background Context
A paucity of data exists studying outcomes of patients with syringomyelia undergoing spinal deformity correction. The literature does not stratify patients by syrinx size, which is likely a major contributor to outcomes.Purpose
The study aimed to compare differences in outcomes between patients with large (≥4?mm) and small syrinxes (<4?mm) undergoing spinal deformity correction.Design
This is a retrospective review.Patient Sample
The sample included 28 patients (11 with large syrinx [LS, >4?mm] and 17 with small syrinx [SS, <4?mm]).Outcome Measures
The outcome measures were radiographic, operative, and neurophysiological measures.Methods
We retrospectively reviewed 28 patients with syringomyelia who underwent spine deformity surgery with 2-year follow-up. Demographic, surgical, and radiographic data were collected and compared preoperatively and at 2 years.Results
The LS group (11 patients) trended toward more left-sided thoracic curves (36% vs. 18%, p=.38) and was more likely to have had a Chiari decompression (45% vs. 12%, p=.08). The LS patients had larger preoperative major curves (LS=66° vs. SS=57°, p=.05), more thoracic kyphosis (LS=42°, SS=24°, p<.01), and greater rib prominences (LS=16°, SS=13°, p=.04). The LS patients had more levels fused (LS=12.2, SS=11.2, p=.05), higher estimated blood loss (EBL) (LS=1068?cc, SS=832?cc, p=.04), and a trend toward less percent correction of the major curve (LS=57%, SS=65%, p=.18). Four of 11 LS patients (36%) did not have somatosensory evoked potentials, and one of these also did not have motor evoked potentials. Neuromonitoring changes occurred in 3 of 11 (27%) LS patients and in none of the SS patients, with no postoperative deficits.Conclusions
Outcomes of patients with syringomyelia undergoing spine deformity surgery are dependent on the size of the syrinx. Those with large syringomyelia are fused longer with more EBL and less correction. Spine surgeons should be aware that these patients are more likely to have less reliable neuromonitoring, with a higher chance of experiencing a change. 相似文献20.
Dustin B. Wygant Paul A. Arbisi Kevin J. Bianchini Robert L. Umlauf 《The spine journal》2017,17(4):505-510