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1.
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2.
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3.
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4.
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5.
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
Background Context
Psychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.Purpose
To examine the relationships among resilience, pain self-efficacy, and disability in spine patients.Design/Setting
Prospective, single-center orthopedic spine clinic.Patient Sample
One hundred and ninety five patients in a tertiary spine practice recruited between December 2016 and March 2017.Outcome Measures
Self-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire 2 (PSEQ-2) Short Form, Neck Disability Index (NDI), and Oswestry Disability Index (ODI).Methods
A prospective study was conducted of new patients visiting an orthopedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the six-question BRS, the two-question PSEQ-2 Short Form, and NDI or ODI for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.Results
A total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% men [83/180]; mean age 53 [standard deviation: 17] years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r=?0.61, p<.0001) and moderately negatively correlated with ODI (r=?0.34, p<.0001). PSEQ-2 was strongly negatively correlated with NDI (r=?0.69, p<.0001) and strongly negatively correlated with ODI (r=?0.62, p<.0001). BRS was moderately positively correlated with PSEQ-2 (r=0.36, p<.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=.0003); this difference was not noted in the neck pain cohort (p=.34).Conclusions
Low resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention. 相似文献6.
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7.
Dilip Chand Raja S. Ajoy Prasad Shetty Balavenkat Subramanian Rishi Mugesh Kanna S. Rajasekaran 《The spine journal》2019,19(4):569-577
Background Context
Surgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain caused by central sensitization. The role of pre-emptive analgesia (PA) and intraoperative analgesia in management of postoperative pain has gained precedence over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory, and neuronal stimuli. Blockage of all three stimuli in the perioperative period by pre-emptively administrating a combination of paracetamol (P), ketorolac (K), and pregabalin (PR) might help in adequate management and alleviation of acute postoperative pain.Purpose
To evaluate the analgesic effect of a combination of P, K, and PR as pre-emptive multimodal analgesia, aimed to block or reduce acute postoperative pain after spine surgery.Study Design
A prospective, randomized, controlled, and double-blinded clinical trial.Patient Sample
After Institutional Review Board approval, 100 consecutive patients requiring single- or double level spinal fusion procedures were randomized into two groups—PA and control (C).Methods
The PA group received P, K, and PR 4 hours before surgery, as PA. Both groups underwent identical anesthetic and postoperative pain management protocol.Outcome Measures
Demographic and surgical data, 4 hourly postoperative pain levels—Numeric Pain Rating scale (NRS), Ambulatory NRS scores; level of consciousness—Ramsay sedation scale, total amount of opioids consumed (TOC) through patient-controlled analgesia; functional levels—Oswestry Disability Index (ODI), surgical satisfaction index-North American Spine Society (NASS) satisfaction scale, duration of hospital stay, and all complications were recorded and analyzed. A research grant of 6,032 USD was obtained from AO Spine toward this work. There is no conflict to disclose.Results
Both the groups had identical demographic backgrounds and surgical profiles. The average NRS score within the first 48-hour period in the PA group (2.7±0.79) was significantly less than the C group (3.4±0.98) and the differences were more in the first 12 hours following surgery. Similarly, Ambulatory NRS scores were significantly low in the PA group during the first and second postoperative days. The PA group individuals were found to be more physically motivated, as 95.7% were able to ambulate 50 m on the first postoperative day compared with 30% in the C group. The PA group had significantly low TOC (3.02±2.29 mg) in comparison to the C group (4.94±3.08 mg). The duration of hospital stay was 4.17±1.02 and 4.84±1.62 days in the PA and C groups (p=.017), respectively. No major complications occurred in either groups and were found to be similar in percentage between both the groups, except for nausea and vomiting which were more in C group. Dry mouth was the most common side effect noted irrespective of the groups. All patients had significant improvement in ODI with better results in PA group at first month follow up. The PA group (97.90%) was extremely satisfied compared with C group (72%, p=.002) according to NASS scale.Conclusions
Postoperative pain management in spine surgery is maximized if perioperative painful stimuli can be inhibited, which requires adequate blood levels of analgesic, anti-inflammatory, and neuropathic drugs intraoperatively. The employed strategy of preoperative administration of balanced analgesia with a combination of P, K, and PR, each having different mechanisms of action, resulted in lesser pain intensity, allowed better ambulation tolerance, improved functional outcomes and has also reduced the requirement of opioids and duration of hospital stay with no additional complications. Thus, this balanced analgesia administered preoperatively would address the complicated postsurgical pain. 相似文献8.
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9.
BACKGROUND CONTEXT
The kinematics of the lumbar region and the activation patterns of the erector spinae muscle have been associated with the genesis of low back pain, which is one of the most common complications associated with pregnancy. Despite the high prevalence of pregnancy-related low back pain, the biomechanical adaptations of the lumbar region during pregnancy remain unknown.PURPOSE
This study analyzes lumbar spine motion and the activation pattern of the lumbar erector spinae muscle in healthy pregnant women.STUDY DESIGN
A case-control study.PATIENT SAMPLE
The study involved 34 nulliparous women (control group) and 34 pregnant women in the third trimester (week 36 ± 1).OUTCOME MEASURES
We recorded the parameters of angular displacement of the lumbar spine in the sagittal plane during trunk flexion-extension, and the EMG activity of the erector spinae muscles during flexion, extension, eccentric and concentric contractions, and the myolectrical silence.METHODS
The participants performed several series of trunk flexion-extension movements, which were repeated 2 months postpartum. The position of the lumbar spine was recorded using an electromagnetic motion capture system. EMG activity was recorded by a surface EMG system and expressed as a percentage of a submaximal reference contraction.RESULTS
Antepartum measurements showed a decrease (relative to control and postpartum measurements) in lumbar maximum flexion (52.5 ± 10.5° vs 57.3 ± 7.7° and 58.7 ± 8.6°; p < .01), the percentage of lumbar flexion during forward bending (56.4 ± 5.6% vs 59.4 ± 6.8% and 59.7 ± 5.6%; p < .01), and the time keeping maximum levels of lumbar flexion (35.7 ± 6.7% vs 43.8 ± 5.3% and 50.1 ± 3.7%; p < .01). Higher levels of erector spinae activation were observed in pregnant women during forward bending (10.1 ± 4.8% vs 6.3 ± 2.4% and 6.6 ± 2.7%; p < .01) and eccentric contraction (12.1 ± 5.2% vs 9.4 ± 3.1% and 9.1 ± 2.9%; p < .01), as well as a shortened erector spinae myoelectric silence during flexion.Conclusions
Pregnant women show adaptations in their patterns of lumbar motion and erector spinae activity during trunk flexion-extension. These changes could be associated with the genesis of pregnancy-related low back pain, by means of biomechanical protection mechanisms against the increase on abdominal mass and ligamentous laxity. 相似文献10.
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11.
Bong Gun Lee Jung-Hwan Choi Dong-Yun Kim Won Rak Choi Seung Gun Lee Chang-Nam Kang 《The spine journal》2019,19(2):301-305
Background context
It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.Purpose
The purpose of this study was to investigate the risk factors for newly developed OVCFs after treatment by vertebroplasty (VP), kyphoplasty (KP), or conservative treatment.Study design/setting
A retrospective comparative study.Patient sample
One hundred thirty-two patients who had radiographic follow-up data for one year or longer among 356 patients who were diagnosed with OVCF and underwent VP, KP or conservative treatment between March 2007 and February 2016.Outcome measures
All records were examined for age, sex, body mass index (BMI), rheumatoid arthritis and other medical comorbidities, osteoporosis medication, bone mineral density (BMD), history of vertebral and nonvertebral fractures, treatment methods used, level of fractures, and presence of multiple fracture sites.Methods
Patients were divided into those who manifested new OVCF (Group A) and those who did not (Group B). For the risk factor analysis, student's t-tests and chi-square tests were used in univariate analysis. Multivariate logistic regression analysis was carried out on variables with a p<.1 in the univariate analysis.Results
Newly developed OVCFs occurred in 46 of the 132 patients (34.8%). Newly developed OVCF increased significantly with factors such as average age (p=.047), low BMD T-score of the lumbar spine (p=.04) and of the femoral neck (p=.046), advanced age (>70 years) (p=.011), treatment by cement augmentation (p=.047) and low compliance with osteoporosis medication (p=.029). In multivariate regression analysis, BMD T-score of the lumbar spine (p=.009) and treatment by cement augmentation (p=.044) showed significant correlations with the occurrence of new OVCFs with a predictability of 71.4%.Conclusion
Osteoporotic vertebral compression fracture patients with low BMD T-score of the lumbar spine and those who have been treated by cement augmentation have an increased risk of new OVCFs after treatment and, therefore, require especially careful observation and attention. 相似文献12.
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13.
Koji Tamai Akinobu Suzuki Akito Yabu Shinji Takahashi Hiromitsu Toyoda Masatoshi Hoshino Hidetomi Terai Hiroaki Nakamura 《The spine journal》2019,19(2):246-252
Background Context
The impact of preoperative facet degeneration (FD) on surgical outcomes following laminoplasty has not been established.Purpose
To elucidate the influence of preoperative FD on pre and postoperative clinical symptoms and radiographic parameters.Study Design
Retrospective analysis of prospectively collected data.Patient Sample
A total of 135 consecutive patients who underwent laminoplasty for cervical spondylotic myelopathy with greater than 2 years follow-up.Outcome Measures
The cervical Japanese Orthopedic Association score, visual analog scale, Short Form-36, Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire, and radiographic parameters (C7 slope, C2–C7 sagittal vertical axis, C2–C7 lordotic angle, and scoring of FD).Methods
FD severity of the bilateral facets of C2–3 to C7–T1 was graded using preoperative computer tomography images. Patients were divided into two quantiles according to the mean score of their FD grading: mild (n=69) and severe FD groups (n=66). The preoperative clinical score and radiographic parameters of the two groups were compared. Variables with p<.05 were included in the multinomial logistic regression model. The changes in clinical scores and radiographic parameters between both groups (from the preoperative to 2-year postoperative period) were compared using a mixed-effect model, after adjusting for age and sex.Results
Mean age and neck pain visual analog scale were independently associated with FD severity (age: p=.004, neck pain: p=.004). However, the other preoperative clinical scores and radiographic parameters were not significantly different. In terms of the change in clinical scores 2 years postlaminoplasty, no significant differences between the severe and mild FD groups were noted. While the mild FD group had a reduced C2–C7 lordotic angle, the severe FD group demonstrated an increased C2–C7 lordotic angle 2 years postlaminoplasty (p=.044). The change in C7 slope and C2–C7 sagittal vertical axis showed no significant differences.Conclusions
Preoperative FD severity did not influence the 2-year surgical outcomes of laminoplasty, in terms of improvement in myelopathy, patient-oriented score of quality of life, physical and mental status, as well as neck pain. Furthermore, preoperative FD severity correlated with neither preoperative cervical imbalance nor balance deterioration after laminoplasty. These results may encourage physicians to consider laminoplasty for patients with cervical spondylotic myelopathy, regardless of the severity of FD. 相似文献14.
BACKGROUND
The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.PURPOSE
The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.STUDY DESIGN/SETTING
Double blinded randomized controlled clinical trial.PATIENT SAMPLE
A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.OUTCOME MEASUREMENT
Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.METHOD
A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.RESULTS
VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.CONCLUSIONS
Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure. 相似文献15.
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16.
Bryan S. Lee Rod Nault Matthew Grabowski Benjamin Whiting Joseph Tanenbaum Konrad Knusel Matthew Poturalski Todd Emch Thomas E. Mroz Michael P. Steinmetz 《The spine journal》2019,19(2):191-198
BACKGROUND CONTEXT
Routine use of magnetic resonance imaging (MRI) as a diagnostic tool in lumbar stenosis is becoming more prevalent due to the aging population. Currently, there is no clinical guideline to clarify the utility of repeat MRI in patients with lumbar stenosis, without instability, neurological deficits, or disc herniation.PURPOSE
To evaluate the utility of routine use of MRI as a diagnostic tool in lumbar stenosis, and to help formulate clinical guidelines on the appropriate use of preoperative imaging for lumbar stenosis.STUDY DESIGN/SETTING
Retrospective radiographic analysis.PATIENT SAMPLE
Retrospective chart review was performed to review patients with lumbar stenosis, who underwent lumbar decompression without fusion from 2011 to 2015 at a single institution.OUTCOME MEASURES
Previously established stenosis grading systems were used to measure and compare the initial and the subsequent repeat lumbar MRIs performed preoperatively. If patients were found to have a moderate or severe grade change, and if the surgical plan was altered due to such exacerbated radiographic findings, then their grade changes were considered clinically meaningful.METHODS
We identified patients with lumbar stenosis without radiographic instability or neurological deficits, who had at least two preoperative lumbar MRIs performed and underwent decompressive surgeries. At each pathologic disc level, the absolute value of the change in grade for central and lateral recess stenosis, right foraminal stenosis, and left foraminal stenosis from the first preoperative MRI to the repeated MRI was calculated. These changed data were then used to calculate the mean and median changes in each of the three types of stenosis for each pathologic disc level. Identical calculations were carried out for the subsample of patients who only underwent discectomy or had a discectomy included as part of their surgery.RESULTS
Among the 103 patients who met the inclusion criteria, 37 of those patients had more than one level surgically addressed, and a total of 161 lumbar levels were reviewed. Among the subset of patients that had any grade change, the majority of the grades only had a mild change of 1 (36 out of 42 patients, 85.7%, 95% confidence interval [CI]: 73.1%–94.1%); there was a moderate grade change of 2 in two patients (4.8%, CI: 0.8%–14.0%), and a severe change of 3 in one patient (2.4%, CI: 0.2%–10.1%). There were three patients with decreased grade change (7.1%, CI: 1.8%–17.5%). All clinically meaningful grade changes were from the subset of patients who had only discectomy or discectomy as part of the procedure. Lastly, both patients that had a clinically meaningful grade change had their MRIs performed at an interval of greater than 360 days.CONCLUSIONS
The radiographic evaluation of the utility of routinely repeated MRIs in lumbar stenosis without instability, neurological deficits, or disc herniations demonstrated that there were no significant changes found in the repeated MRI in the preoperative setting, especially if the MRIs were performed less than one year apart. The results of this present study can help to standardize the diagnostic evaluation of lumbar stenosis and to formulate clinical guidelines on the appropriate use of preoperative imaging for lumbar stenosis patients. 相似文献17.
Steven D. Glassman Leah Y. Carreon Morgan E. Brown Jeffrey S. Jones Jean Edward Jing Li Mark V. Williams 《The spine journal》2019,19(4):711-716
BACKGROUND CONTEXT
Health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” has been demonstrated to affect access to care and appropriate healthcare utilization.PURPOSE
To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain.STUDY DESIGN
Cross sectional.PATIENT SAMPLE
Patients seen at a multisurgeon spine specialty clinic.OUTCOME MEASURES
Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0–10) for back and leg pain.METHODS
The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities.RESULTS
Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p?=?.017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8).CONCLUSIONS
Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes. 相似文献18.
19.
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20.
Man-Kyu Park Kyoung-Tae Kim Woo-Seok Bang Dae-Chul Cho Joo-Kyung Sung Young-Seok Lee Chang Kyu Lee Chi Heon Kim Brian K. Kwon Won-Kee Lee Inbo Han 《The spine journal》2019,19(3):437-447