共查询到20条相似文献，搜索用时 15 毫秒
1.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468
BACKGROUND CONTEXT
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.PURPOSE
To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.STUDY DESIGN/SETTING
Cross-sectional diagnostic study.PATIENT SAMPLE
Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP and TSE high bandwidth sequences).OUTCOME MEASURES
Sensitivity and specificity in detection of screw loosening for each imaging modality.METHODS
Screw torque force was measured intraoperatively and compared with preoperative screw loosening signs such as peri-screw edema in MRI and peri-screw osteolysis in CT and radiographs. A torque force of less than 60 Ncm was used to define a screw as loosened.RESULTS
Sensitivity and specificity in detection of screw loosening was 43.9% and 92.1% for MRI, 64.8% and 96.7% for CT, and 54.2% and 83.5% for standard radiographs, respectively.CONCLUSIONS
Despite improvement of MRI with metal artifact reduction MRI technique, CT remains the modality of choice. Even so, CT fails to detect all loosened pedicle screws. 相似文献2.
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3.
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4.
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5.
Masashi Uehara Jun Takahashi Shota Ikegami Ryosuke Tokida Hikaru Nishimura Noriko Sakai Hiroyuki Kato 《The spine journal》2019,19(2):349-356
BACKGROUND CONTEXT
It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.OBJECTIVES
In this study of an aged Japanese population, we employed random sampling from the basic resident registry of a rural town for subject selection to determine reference values of sagittal spinal alignment including the cervical spine.STUDY DESIGN
Japanese resident cohort study based on a municipal registry.PATIENT SAMPLE
A total of 413 aged people randomly sampled from the resident registry of a rural Japanese town.OUTCOME MEASURES
All subjects underwent a whole spine lateral radiograph for measurement of sagittal spinal alignment parameters.METHODS
Registered citizens of 50 to 89 years old were targeted for this survey. We established eight groups based on age (50s, 60s, 70s, and 80s) and gender (male and female) after random sampling from the resident registry of Obuse town in 2014. A total of 413 people (203 males and 210 females) were enrolled. Radiographic parameters of sagittal spinal alignment of the cohort were measured and analyzed. Funding for this study was provided by the Japan Orthopaedics and Traumatology Research Foundation (10,000 USD), the Japanese Orthopaedic Association (5,000 USD), the Japanese Society for Musculoskeletal Medicine (40,000 USD), and the Nakatomi Foundation (15,000 USD).RESULTS
Global spinal alignments became more misaligned with age for both genders. Sagittal vertical axis (SVA) forward shift was significantly more frequent in 80s males and 70s females, and SVA in 80s females was a mean of 66 mm forward of that of 50s females. Cervical protrusion was markedly greater in 60s males onwards. In women, lumbar lordosis and posterior pelvic inclination were noticeable from a younger age than in men. The amount of pelvic tilt misalignment in female subjects was approximately 10 years earlier than their male counterparts.CONCLUSIONS
This first resident cohort of Japanese individuals determined average spinal alignment parameters by age and gender. Spinal balance generally shifts forward as age increases. A forward shift in the upper cervical spine occurs first in men, whereas lumbopelvic alignment shift occurs first in women. 相似文献6.
Victor E. Staartjes Alessandro Siccoli Marlies P. de Wispelaere Marc L. Schröder 《The spine journal》2019,19(4):637-644
BACKGROUND
In modern clinical research, the accepted minimum follow-up for patient-reported outcome measures (PROMs) after lumbar spine surgery is 24 months, particularly after fusion. Recently, this minimum requirement has been called into question.PURPOSE
We aim to quantify the concordance of 1- and 2-year PROMs to evaluate the importance of long-term follow-up after elective lumbar spine surgery.STUDY DESIGN
Retrospective analysis of data from a prospective registry.PATIENT SAMPLE
We identified all patients in our prospective institutional registry who underwent degenerative lumbar spine surgery with complete baseline, 12-month, and 24-month follow-up for ODI and numeric rating scales for back and leg pain (NRS-BP and NRS-LP).OUTCOME MEASURES
Oswestry Disability Index (ODI) and NRS-BP and NRS-LP at 1 year and at 2 years.METHODS
We evaluated concordance of 1- and 2-year change scores by means of Pearson's product-moment correlation and performed logistic regression to assess if achieving the minimum clinically important difference (MCID) at 12 months predicted 24-month MCID. Odds ratios (OR) and their 95% confidence intervals (CI), as well as model areas-under-the-curve were obtained.RESULTS
A total of 210 patients were included. We observed excellent correlation among 12- and 24-month ODI (r?=?0.88), NRS-LP (r?=?0.76) and NRS-BP (r?=?0.72, all p <.001). Equal results were obtained when stratifying for discectomy, decompression, or fusion. Patients achieving 12-month MCID were likely to achieve 24-month MCID for ODI (OR: 3.3, 95% CI: 2.4–4.1), NRS-LP (OR: 2.99, 95% CI: 2.2–4.2) and NRS-BP (OR: 3.4, 95% CI: 2.7–4.2, all p <.001) with excellent areas-under-the-curve values of 0.81, 0.77, and 0.84, respectively. Concordance rates between MCID at both follow-ups were 87.2%, 83.8%, and 84.2%. A post-hoc power analysis demonstrated sufficient statistical power.CONCLUSIONS
Irrespective of the surgical procedure, 12-month PROMs for functional disability and pain severity accurately reflect those at 24 months. In support of previous literature, our results suggest that 12 months of follow-up may be sufficient for evaluating spinal patient care in clinical practice as well as in research. 相似文献7.
Background context
Lumbar pedicle screw placement can be technically challenging. Malpositioned screws occur in up to 15% of patients and could result in radiculopathy or instrumentation failure.Purpose
To compare intraoperative electromyography (EMG) and image guidance using an O-arm for identifying pedicle breach during elective lumbar fusion.Study design
Prospective observational study.Patient sample
All adult patients undergoing elective lumbar spinal fusion operations for degenerative spine disorders (including adjacent segment degeneration, degenerative scoliosis, and symptomatic spondylosis and spondylolisthesis) at a single institution from July 1, 2014, to December 1, 2015, were prospectively tracked.Outcome measures
Pedicle breach.Methods
Pedicle screws from L2–S1 were placed using C-arm assisted freehand technique. All screws were stimulated with EMG and evaluated using the O-arm intraoperative imaging system. Electromyography data were compared with intraoperative images to assess the accuracy of identifying pedicle breaches. No funding was received for this work.Results
One thousand six lumbar pedicles screws were placed from L2 to S1 in 164 consecutive cases. The mean patient age was 59.2 years. Thirty-five breaches (15 lateral and 20 medial) were visualized with O-arm imaging and confirmed by palpation (3.5% of screws placed). Of the breaches, 14 screws stimulated below the 12-mA threshold, nine screws stimulated between 12 and 20 mA, and 12 screws did not generate an EMG response. Forty screws stimulated below a 12-mA threshold but showed no breach on imaging. Using the 12-mA threshold, the sensitivity of EMG was 40%, specificity was 96%, positive predictive value was 26%, and negative predictive value was 98%. All 35 breached screws were corrected during surgery. There were no postoperative symptoms caused by breached screws and no patients required reoperation.Conclusions
Our findings indicate that EMG may not be a highly reliable tool in determining an anatomical breach during placement of lumbar pedicle screws. O-arm may be better for detecting either medial or lateral breaches than EMG stimulation if there are concerns about screw placement or for confirmation of placement before leaving the operating room. 相似文献8.
Carolyn E. Schwartz Jie Zhang Bruce D. Rapkin Joel A. Finkelstein 《The spine journal》2019,19(4):726-734
Background Context
Underlying cognitive factors have been found to influence patients’ symptom experience. Current evidence suggests that concomitant changes in appraisal must be taken into account to accurately interpret change as measured by standard spine patient-reported outcomes (PROs).Purpose
To investigate changes in patients’ minimally important differences (MID) over recovery from spinal surgery; whether and how cognitive appraisal processes are implicated in the change trajectories.Study Design/Setting
Longitudinal cohort study with up to 12 months follow-up.Patient Sample
Surgical patients (n?=?167) with a diagnosis of disc herniation or spinal stenosis.Outcome Measures
Standard spine patient-reported PROs were used (Rand-36, Oswestry Disability Index, Numerical Rating Scale for pain, PROMIS Pain Impact).Methods
This study was funded by the Feldberg Chair in Spinal Research, Sunnybrook Health Sciences Centre and the authors have no conflicts of interest. MID used an anchor technique and was computed by global assessment of change (GAC) grouping. Participants were binned into groups based on their GAC response patterns at all time points: Consistently better post-surgery, consistently worse post-surgery, and bouncers, whose GAC ratings fluctuate (ie, better-then-worse-then-better; or vice versa). Individuals’ longitudinal quality of life (QOL) and appraisal slope scores were computed. QOL-appraisal slopes’ correlations were computed by GAC group. Fisher's Z transformation tested the hypothesis that GAC groups differed in the QOL-appraisal relationship over time.Results
Moderate to large changes are recognized as clinically important in the early stages of recovery (ie, 6 weeks post-surgery), and over time smaller and smaller changes become important. The three pattern groups emphasized and deemphasized different standards of comparison over time, with the Better group emphasizing personal goals and the Worse and Bouncers deemphasizing doctors’ input. These group differences translated to differential relationships between PRO change and appraisal changes over time.Conclusions
The MID reflects increasingly subtle change over time in PROs. Appraisal may influence how patients experience the same (MID) change over time, with better outcomes associated with emphasizing long-term goals. PRO change seems to be driven by different standards of comparison. Potential avenues for clinical intervention are discussed. 相似文献9.
Nagy Mekhail Diana Mehanny Sherif Armanyous Youssef Saweris Shrif Costandi 《The spine journal》2019,19(3):476-486
BACKGROUND CONTEXT
Chronic pain and obesity are both on the rise. Spinal cord stimulation has gained increasing popularity in the pain management field for the treatment of spine-related chronic pain, however to-date, the correlation between the spinal cord stimulator effectiveness and increasing body mass index (BMI) has not been fully established.PURPOSE
We aimed to investigate the correlation between patients’ BMI and the percentage of pain relief as well as opioid utilization in chronic spine-related pain patients treated with spinal cord stimulation.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Patients with chronic spine-related pain who were treated with a spinal cord stimulator.OUTCOME MEASURES
Eleven-point numeric rating scale for pain and opioid utilization.METHODS
Following Institutional Review Board approval, data from all eligible subjects who had undergone successful spinal cord stimulation (SCS)-trial defined as ≥50% decrease in pain followed by SCS implant were collected and statistically analyzed. Patients were divided into four groups according to BMI. Self-reported pain scores on the 11-point numerical rating scale were collected at baseline, 6 months and 12 months post SCS-implant visits. Opioid utilization, if any, was collected at baseline and 12 months post-SCS implant.RESULTS
In all, 181 patients were included. Thirty-three were under and/or normal weight (≤24.9 kg/m2), 72 overweight (25.0–29.9 kg/m2), 63 obese (30.0–39.9 kg/m2), and 13 morbidly obese (≥40.0 kg/m2). The estimated coefficients from multivariable linear regression analysis were ?1.91% (95% CI: ?2.82% to ?0.991%) and ?1.48% (95% CI: ?2.30% to ?0.660%) reduction in pain improvement per unit increase of BMI for 6 months and 12 months scores, respectively. The estimated coefficient of disability status was ?15.3% (95% CI: ?22.1% to ?8.48%). The estimated coefficient for 12 month opioid equivalence was ?0.08% (95% CI: ?0.14 to ?0.021), per` 1 mg unit increase of morphine opioid equivalency. The data showed a statistically significant negative association between increasing BMI and SCS effectiveness at 6 and 12 months post-SCS therapy with a 2% reduction in efficacy for every unit increase of BMI after adjusting for confounding factors and a 20% better response in underweight and/or normal patients over the morbidly obese individuals which was not related to baseline pain score level. The significant difference in pain scores at 6 months (p = .0003) and 12 months (p = .04) post-SCS implant between obese and nonobese patients was not attributable to differences in baseline pain scores. There was no significant change in opioid utilization between baseline and 12 months post-SCS therapy.CONCLUSION
A negative association between SCS effectiveness and increasing BMI was found, whereas, no significant difference was noted amongst the various BMI cohorts and the daily opioid consumption. 相似文献10.
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11.
Sung Hyun Noh Kyung Hyun Kim Dong Ah Shin Jeong Yoon Park Seong Yi Sung Uk Kuh Keung Nyun Kim Dong Kyu Chin Keun Su Kim Do Heum Yoon Yong Eun Cho 《The spine journal》2019,19(2):276-284
BACKGROUND CONTEXT
Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases.PURPOSE
The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors.STUDY DESIGN
A retrospective chart review was performed.PATIENT SAMPLE
We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma.OUTCOME MEASURES
We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy.METHODS
The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared.RESULTS
Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05).CONCLUSIONS
Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered. 相似文献12.
Xiang Yu Ben Wang ShaoMin Yang SongBo Han Liang Jiang XiaoGuang Liu Feng Wei FengLiang Wu Lei Dang ZhongJun Liu 《The spine journal》2019,19(3):509-515
BACKGROUND CONTEXT
Both open surgical resection (OSR) and radiofrequency ablation (RFA) have been reported for spinal osteoid osteoma (OO).PURPOSE
To verify the clinical safety and efficiency of RFA with OSR in treating spinal OO.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Twenty-eight consecutive patients with spinal OO who underwent either RFA or OSR in our institute between September 2006 and December 2016.OUTCOME MEASURES
The age, gender, lesion distribution, surgical time, estimated blood loss, complications, local recurrence, visual analogue scale (VAS), and the modified Frankel grade were documented.METHODS
We retrospectively reviewed 28 patients with spinal OO who had been treated in our hospital from September 2006 to December 2016. Patients were followed at 3, 6, 12, and 24 months after the index surgery. The minimum follow-up period was 12 months. This study was funded by Peking University Third Hospital (Y71508-01) (¥ 400,000).RESULTS
Twelve and 16 patients were treated with CT-guided percutaneous RFA and OSR, respectively. Spinal OO locations were cervical in 4, thoracic in 4, lumbar in 3, and sacral vertebra in 1 in the RFA group and cervical in 12, thoracic in 1, and lumber in 3 in the OSR group. RFA showed shorter operating time, less blood loss, and less in-hospital stay than open surgery [105.0 ± 33.8 minutes vs. 186.4 ± 53.5 minutes (p < .001), 1 (0 to 5) ml vs. 125 (30–1200) ml (p < .001) and 1 (1–3) days vs. 6 (3–10) days (p < .001), respectively]. At last follow-up, one patient underwent a secondary RFA for recurrence. VAS improvement was 7.5 (3–10) and 6.5 (4–9) (p = .945) in the RFA and OSR groups, respectively. The overall complication rate was 8.3% (1/12) and 18.8% (3/16) in the RFA and OSR groups, respectively.CONCLUSIONS
If there is sufficient cerebrospinal fluid between the spinal OO lesion and spinal cord/nerve root (more than 1 mm), RFA is effective and safe for treatment of well-selected spinal OO, showing reduced operating time, blood loss, in-hospital stay, and complications compared to OSR. However, OSR is still recommended in cases with spinal cord/nerve root compression. 相似文献13.
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14.
Eva Jacobs Sander M.J. van Kuijk Johannes M.R. Merk Mieke Vandewall-Peeters Liesbeth M.C. Jütten-Brouwer Lodewijk W. van Rhijn Paul C. Willems 《The spine journal》2019,19(4):655-661
BACKGROUND CONTEXT
Degenerative lumbar scoliosis (DLS) is an increasingly common spinal disorder of which current management is characterized by a substantial variety in treatment advice. To improve evidence-based clinical decision-making and increase uniformity and transparency of care, the Scoliosis Research Society established appropriateness criteria for surgery for DLS. In these criteria, however, the patient perspective was not formally incorporated. Since patient perspective is an increasingly important consideration in informed decision-making, embedding patient-reported outcome measures (PROMs) in the appropriateness criteria would allow for an objective and transparent patient-centered approach.PURPOSE
To evaluate the extent that patient perspective is integrated into the appropriateness criteria of surgery for DLS.STUDY DESIGN
Single center, retrospective, cohort study.PATIENT SAMPLE
150 patients with symptomatic degenerative lumbar scoliosis.Outcome Measures
The association between appropriateness for surgery and various PROMs [Visual Analogue Scale for pain, Short Form 36 (SF-36), Pain Catastrophizing Scale (PCS), Hospital Anxiety Depression Scale (HADS), and Oswestry Disability Index (ODI)].METHODS
Medical records of all patients with symptomatic DLS were reviewed and scored according to the appropriateness criteria. To assess the association between the appropriateness criteria and the validated PROMs, analysis of variance was used to test for differences in PROMS for each of the three categories resulting from the appropriateness criteria. To assess how well PROMs can discriminate between appropriate and inappropriate, we used a logistic regression analysis. Discriminative ability was subsequently determined by computing the area under the curve (AUC), resulting from the logistic regression analysis. Spearman rank analysis was used to establish a correlation pattern between the PROMs used and the appropriateness criteria.RESULTS
There was a significant association between the appropriateness of surgery and the PROMs. The discriminative ability for appropriateness of surgery for PROMs as a group was strong (AUC of 0.83). However, when considered in isolation, the predictive power of any individual PROMs was poor. The different categories of the appropriateness criteria significantly coincided with the PROMs used.CONCLUSION
There is a statistically significant association between the appropriateness criteria of surgery for DLS and PROMs. Implementation of PROMs into the appropriateness criteria may lead to more transparent, quantifiable and uniform clinical decision making for DLS. 相似文献15.
Shinichi Ishihara Nobuyuki Fujita Koichiro Azuma Takehiro Michikawa Mitsuru Yagi Takashi Tsuji Michiyo Takayama Hideo Matsumoto Masaya Nakamura Morio Matsumoto Kota Watanabe 《The spine journal》2019,19(3):493-500
BACKGROUND CONTEXT
Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted.PURPOSE
To elucidate potential association between SEL and metabolic syndrome.STUDY DESIGN
An observational study used data of a medical checkup.PATIENT SAMPLE
We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study.OUTCOME MEASURES
The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated.METHODS
The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated.RESULTS
The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL.CONCLUSION
This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome. 相似文献16.
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17.
Mirjam Renovanz Julian Haaf Rebecca Nesbigall Angelika Gutenberg Wilfried Laubach Florian Ringel Sabine Fischbeck 《The spine journal》2019,19(3):523-531
BACKGROUND CONTEXT
Informed consent is mandatory before surgery and fundamental in the physician-patient interaction. However, communication is sometimes suboptimal.PURPOSE
The objective was to develop a question prompt list (QPL) for patients undergoing spine surgery (spinal neurosurgery-QPL, “SN-QPL”) to encourage them to acquire information during the informed consent consultation (ICC) and assess patients’ information needs.STUDY DESIGN/SETTING
We conducted a prospective uncontrolled single center study in order to develop a QPL for patients undergoing spine surgery.PATIENT SAMPLE
Patients inclusion criteria were as follows: (1) planned spinal surgery, (2) age 18 to 80 years, (3) legal capacity, (4) ability to understand and respond to questionnaires, and (5) informed consent.OUTCOME MEASURES
We applied the following self-report measures: the developed preliminary QPL with regard to surgery topics and assessment of patients’ information needs.METHODS
First, we performed a literature review, patient interviews, and two expert rounds. Subsequently, we validated a preliminary SN-QPL including 37 items before and after ICC with regard to importance of items and fulfillment of information needs in 118 patients. A principal component analysis followed by varimax rotation revealed the final SN-QPL.RESULTS
For the final version of the SN-QPL, 27 items with following four reliable subscales were derived with satisfactory internal consistency: (1) scale SN-QPL-C, “complications and possible postoperative deficits” (n??=??8 items, Cronbach α?=?0.88); (2) scale SN-QPL-P, “prognosis and follow-up” (n?=?8 items, Cronbach α?=?0.86); (3) scale SN-QPL-I, “preoperative inpatient stay and organizational issues” (n?=?5 items, Cronbach α?=?0.75); and (4) scale SN-QPL-S: “safety of the surgical procedure” (with n?=?6 items, Cronbach α?=?0.84). The most unmet information needs were found in SN-QPL-P. The item with the greatest unmet information needs was “How much professional experience does my surgeon have?”CONCLUSIONS
Our SN-QPL was well-accepted and perceived as helpful by patients awaiting spinal surgeries. It seems to address meaningful items and questions. It could therefore be useful in optimizing pre- and postoperative satisfaction. Further, our study identified many unaddressed questions warranting communication interventions. 相似文献18.
Yanlin Yin Xinwei Liu Xinming Yang Jie Guo Qiang Wang Lixing Chen 《The spine journal》2018,18(12):2323-2332
BACKGROUND CONTEXT
Spondylitis is a rare infection in bone requiring multiple diagnostic strategies for verification.PURPOSE
This study aimed to compare the diagnostic values of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in detecting spondylitis.METHODS
Online PubMed, Embase, and Cochrane Library databases were systematically searched through September 2017 for studies comparing the diagnostic values of 18F-FDG-PET and MRI. The summary sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were calculated using Stata software. The ratio of these indexes between 18F-FDG-PET and MRI was also determined.RESULTS
The summary results for 18F-FDG-PET were as follows: sensitivity=0.96 [95% confidence intervals (CI), 0.84–0.99]; specificity=0.90 (95% CI, 0.79–0.96); PLR=9.83 (95% CI, 4.39–22.03); NLR=0.05 (95% CI, 0.01–0.19); DOR=124.08 (95% CI, 39.04–394.34); and area under the SROC=0.97 (95% CI, 0.95–0.98). The summary sensitivity, specificity, PLR, NLR, DOR, and area under the SROC for MRI were 0.76 (95% CI, 0.65–0.84), 0.62 (95% CI, 0.45–0.77), 2.01 (95% CI, 1.36–2.98), 0.39 (95% CI, 0.27–0.56), 5.08 (95% CI, 2.66–9.69), and 0.77 (95% CI, 0.73–0.80), respectively. The summary results of sensitivity (p=.034), specificity (p=.006), PLR (p<.001), DOR (p<.001), and area under the SROC (p<.001) were higher in 18F-FDG-PET than in MRI. However, NLR (p=.003) was lower in 18F-FDG-PET than in MRI.CONCLUSIONS
18F-FDG-PET had a higher diagnostic value compared with MRI in detecting spondylitis. 相似文献19.
Man Hung Charles L. Saltzman Maren W. Voss Jerry Bounsanga Richard Kendall Ryan Spiker Brandon Lawrence Darrel Brodke 《The spine journal》2019,19(1):34-40
BACKGROUND CONTEXT
The Patient-Reported Outcomes Information System (PROMIS) instruments are an important advancement in the use of PROs, but need to be evaluated with longitudinal data to determine whether they are responsive to change in specific clinical populations.PURPOSE
The purpose of this study was to assess the responsiveness of the PROMIS Physical Function (PF), PROMIS Pain Interference (PI), Neck Disability Index (NDI), and the Oswestry Disability Index (ODI).STUDY DESIGN/SETTING
This study entailed prospective data collection from consecutive patients aged 18 and older, visiting a university-based orthopaedic spine clinic between October 2013 and January 2017.PATIENT SAMPLE
A total of 763 participants in the sample had a mean age of 58 (SD?=?15) years and the sample was 50.2% male and 92.8% Caucasian.OUTCOME MEASURES
The PROMIS PF and PROMIS PI Computerized Adaptive Tests along with either the NDI or ODI instruments were administered on tablet computers before clinic visits. Global rating of change questions relating to pain and function levels was also administered.METHODS
Baseline scores were compared with follow-up scores at four different time-points from 3-months to 6-months and beyond. Patient demographics, mean scores, paired-sample t tests, Standardized Response Mean (SRM), and Effect Size (ES) were analyzed to determine instrument responsiveness. This project was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number U01AR067138 and the authors have no conflicts of interest to disclose.RESULTS
The PROMIS instruments were strongly correlated with each other as well as with the NDI and ODI. Responsiveness was significant on all four instruments at every time-point assessed (paired sample t tests ranged from p?<?.001 to p?=?.049). SRM's were large and over 0.94 for every instrument at every time-point. Cohen's d ES were large and over 0.96 for all at all time-points, except for the NDI which had ES ranging from 0.74 to 0.83. This study showed large effect sizes and responsiveness of the PROMIS PF, PROMIS PI, NDI and ODI in a population of orthopaedic patients with spine pathologies.CONCLUSION
This study demonstrates strong responsiveness of the PROMIS PF and PROMIS PI in a spine clinic population. 相似文献20.
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