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1.
Ronald H.M.A. Bartels Roland D. Donk Wim I.M. Verhagen Allard J.F. Hosman André L.M. Verbeek 《The spine journal》2017,17(11):1625-1632
Background Context
The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance.Purpose
This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis.Study Design
This study is a review of the literature.Patient Sample
This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty.Outcome Measure
The outcome measure used in the study was the MCID.Methods
We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature.Results
We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance.Conclusions
The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement. 相似文献2.
Vincent J. Alentado Stephanie Caldwell Heath P. Gould Michael P. Steinmetz Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(2):236-243
Background Context
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.Purpose
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study Design
This is a retrospective review of patients who underwent instrumented lumbar fusion.Patient Sample
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome Measures
Outcome measures included preoperative and postoperative EQ-5D Index scores.Materials and Methods
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.Results
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.Conclusions
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively. 相似文献3.
Background Context
Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.Purpose
We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol.Study Design/Setting
A meta-analysis of randomized controlled trials was carried out.Patient Sample
Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample.Outcome Measures
Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures.Method
We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models.Results
We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments.Conclusions
Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. 相似文献4.
Shujie Wang Yang Yang Jianguo Zhang Ye Tian Jianxiong Shen Shengru Wang 《The spine journal》2017,17(1):76-80
Background Context
Intraoperative monitoring (IOM) is an essential method for preventing postoperative spinal deficits during posterior vertebral column resection (VCR) surgery for treatment of severe spine deformities, but the IOM features directing at VCR procedures are rarely reported and need to be further clarified.Purpose
To evaluate an important surgical point that will lead to the IOM loss frequently, and then remind the surgeons to pay close attention to impending monitoring changes during posterior VCR surgery.Study Design/Setting
Retrospective study.Patient Sample
A total of 77 patients with severe spine deformities who underwent posterior VCR and deformity correction surgeries from January 2012 to May 2015 are retrospectively analyzed in our spine center.Outcome Measures
IOM (motor-evoked potentials [MEP] and somatosensory-evoked potentials) was used for intraoperative spinal function assessment.Methods
Patients were divided into 2 groups according to their preoperative spinal function, including 27 patients with preoperative spinal deficits and 50 patients with spinal normal. And the IOM data during surgery, especially among VCR procedures, were mainly analyzed in the present study.Results
With the VCR procedure almost complete, most patients showed varying degrees of IOM loss that included 37 cases showing obvious IOM degenerations and 21 cases showing significant IOM loss with alerts immediately. Moreover, the patients with preoperative spinal deficits have more significant decreasing percentage in MEP amplitude (81% vs. 68%, p<.05) than those patients without.Conclusions
With the VCR procedure almost complete, surgeons must pay closely attention to the IOM signals and should be ready to take corresponding surgical measures to deal with the impeding monitoring loss. 相似文献5.
Fredrik Strömqvist Björn Strömqvist Bo Jönsson Magnus K. Karlsson 《The spine journal》2017,17(11):1577-1585
Background Context
Surgical treatment of lumbar disc herniation (LDH) may lead to different outcomes in young, middle-aged, and elderly patients. However, no study has, by the same data ascertainment, evaluated referral pattern, improvement, and outcome in different age strata.Purpose
This study aimed to evaluate referral pattern and outcome in patients of different ages surgically treated because of LDH.Study Design
This is a register study of prospectively collected data.Patient Sample
In SweSpine, the national Swedish register for spinal surgery, we identified 11,237 patients who between 2000 and 2010 had their outcome of LDH surgery registered in pre-, per-, and 1-year postoperative evaluations.Outcome Measures
The data collected included age, gender, smoking habits, walking distance, preoperative duration and degree of back and leg pain, consumption of analgesics, quality of life in the patient-reported outcome measure (PROM) Short-Form 36 (SF-36) and EuroQol 5 dimensions (EQ5D), disability in the Oswestry Disability Index, operated level, type of surgery, and complications.Methods
We compared the outcome in patients within different 10-year age strata. IBM SPSS Statistics 22 was used in the statistical calculations. No funding was obtained for this study. The authors have no conflicts of interest to declare.Results
Patients in all ages referred to surgery had inferior PROM data compared with published normative age-matched PROM data. Referral to LDH surgery demanded of each 10-year strata statistically significantly more pain, lower quality of life, and more disability (all p<.001). Surgery markedly improved quality of life and reduced disability in all age groups (all p<.001), but with statistically significantly less PROM improvement with each older 10-year strata (all p<.001). This resulted in statistically significantly inferior PROM values for pain, quality of life, and disability postoperatively for each 10-year strata (all p<.001). There were also more complications (p<.001) with each 10-year older strata.Conclusions
In general, older patients referred to LDH surgery have statistically significantly inferior PROM scores, improve less, and reach inferior PROM scores postoperatively. The clinical relevance must however be questioned because most patients reach, independent of age group, the defined level for a successful outcome, and the patient satisfaction rate is high. 相似文献6.
Hiroyuki Aono Keisuke Ishii Hidekazu Tobimatsu Yukitaka Nagamoto Shota Takenaka Masayuki Furuya Horii Chiaki Motoki Iwasaki 《The spine journal》2017,17(8):1113-1119
Background Context
Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate.Purpose
The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty.Study Design
This is a prospective multicenter comparative study.Patient Sample
We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty.Outcome Measures
Radiological parameters (Cobb angle on standing lateral radiographs) were used.Methods
Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively.Results
After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty.Conclusions
Temporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma. 相似文献7.
Donald E. Fry Susan M. Nedza Michael Pine Agnes M. Reband Chun-Jung Huang Gregory Pine 《The spine journal》2017,17(11):1641-1649
Background Context
Elective spine surgery is a commonly performed operative procedure, that requires knowledge of risk-adjusted results to improve outcomes and reduce costs.Purpose
To develop risk-adjusted models to predict the adverse outcomes (AOs) of care during the inpatient and 90-day post-discharge period for spine fusion surgery.Study Design/Setting
To identify the significant risk factors associated with AOs and to develop risk models that measure performance.Patient Sample
Hospitals that met minimum criteria of both 20 elective cervical and 20 elective non-cervical spine fusion operations in the 2012–2014 Medicare limited dataset.Outcome Measures
The risk-adjusted AOs of inpatient deaths, prolonged length-of-stay for the index hospitalization, 90-day post-discharge deaths, and 90-day post-discharge readmissions were dependent variables in predictive risk models.Methods
Over 500 candidate risk factors were used for logistic regression models to predict the AOs. Models were then used to predicted risk-adjusted AO rates by hospitals.Results
There were 874 hospitals with a minimum of both 20 cervical and 20 non-cervical spine fusion patients. There were 167,395 total cases. A total of 7,981 (15.9%) of cervical fusion patients and 17,481 (14.9%) of non-cervical fusion patients had one or more AOs for an overall AO rate of 15.2%. A total of 54 hospitals (6.2%) had z-scores that were 2.0 better than predicted with a median risk adjusted AO rate of 9.2%, and 75 hospitals (8.6%) were 2.0 z-scores poorer than predicted with a median risk-adjusted AO rate of 23.2%.Conclusions
Differences among hospitals defines opportunities for care improvement. 相似文献8.
9.
Background Context
Waddell Signs (WS), introduced as a method to establish patients with substantial psychosocial components to their low back pain, carry a negative association despite no literature evaluating whether physical disease is associated with them.Purpose
To compare lumbar magnetic resonance imaging (MRI) findings between the patients with and without WS.Study Design
Retrospective cohort study based on prospectively collected data.Patient Sample
Thirty patients aged 35 to 55 years with an Oswestry Disability Index (ODI) score >50 randomly selected such that there was an even distribution of patients based on the number of WS.Outcome Measures
ODI and Short Form-12 scores, number of WS, presence and severity of spinal pathology.Methods
MRIs were reviewed by three spine specialists blinded to clinical exam findings, number of WS, and patient identity. Type and severity of pathology and presence of surgical and non-surgical lesions were assessed, and findings were rank ordered based on the overall impression of the pathology. There was no external funding or potential conflicts of interest for this study.Results
There were significantly more individual pathologic findings in patients without WS (p=.02). However, there was no difference in the severity of pathology based on WS (p=.46). Furthermore, the rank ordering based on overall impression of severity showed no difference between the patients with and without WS (p=.20). Although 100% of the patients without WS showed pathologic findings on MRI, 70% of WS patients also had significant pathology on MRI. The prevalence of spondylolisthesis, stenosis, and disc herniation was similar (p=.41, p=.22, and p=.43, respectively). The prevalence and mean number of lesion amenable to surgery did not differ based on presence of WS (p=.21 and p=.18, respectively).Conclusions
Patients with WS present a difficult diagnostic challenge for the physician as their organic symptoms are often coexistent with emotional fear avoidance behavior. Although there is more overall pathology in patients without WS, a significant number of these patients appear to have comparable spinal pathology with equivalent severity, which may be contributing to patients' symptoms and disability. Presence of these non-organic symptoms often makes us doubt these patients. However, as part of effective treatment, physicians should better understand both the physical and psychological components of patient disability. 相似文献10.
Geoff P. Bostick 《The spine journal》2017,17(11):1722-1728
Background Context
Psychological treatments delivered by non-psychologists have been proposed as a way to increase access to care to address important psychological barriers to recovery in people with low back pain (LBP).Purpose
This review aimed to synthesize randomized controlled trials (RCTs) that assess the effectiveness of psychological interventions delivered by non-psychologists in reducing pain intensity and disability in adults with LBP, compared with usual care.Study Design
A systematic review without meta-analysis was carried out.Methods
Randomized controlled trials including adult patients with all types of musculoskeletal LBP were eligible. Interventions included those based on psychological principles and delivered by non-psychologists. The primary outcomes of interest were self-reported pain intensity and disability. Information sources included Medline, EMBASE, and the Cochrane Central Registrar for Controlled Trials. The Cochrane Collaboration's tool for assessing risk of bias was used for the evaluation of internal validity.Results
There were 1,101 records identified, 159 were assessed for eligibility, 16 were critically appraised, and 11 studies were included. Mild to moderate risk of bias was present in the included studies, with personnel and patient blinding, treatment fidelity, and attrition being the most common sources of bias. Considerable heterogeneity existed for patient population, intervention components, and comparison groups. Although most studies demonstrated statistical and clinical improvements in pain and disability, few were statistically superior to the comparison group.Conclusions
Consistent with the broader psychological literature, psychological interventions delivered by non-psychologists have modest effects on low back pain and disability. Additional high quality research is needed to understand what patients are likely to respond to psychological interventions, the appropriate dose to achieve the desired outcome, the amount of training required to implement psychological interventions, and the optimal procedures to ensure treatment fidelity. 相似文献11.
Dustin B. Wygant Paul A. Arbisi Kevin J. Bianchini Robert L. Umlauf 《The spine journal》2017,17(4):505-510
Background Context
Waddell et al. identified a set of eight non-organic signs in 1980. There has been controversy about their meaning, particularly with respect to their use as validity indicators.Purpose
The current study examined the Waddell signs in relation to measures of somatic amplification or over-reporting in a sample of outpatient chronic pain patients. We examined the degree to which these signs were associated with measures of over-reporting.Study Design/Setting
This study examined scores on the Waddell signs in relation to over-reporting indicators in an outpatient chronic pain sample.Patient Sample
We examined 230 chronic pain patients treated at a multidisciplinary pain clinic. The majority of these patients presented with primary back or spinal injuries.Outcome Measures
The outcome measures used in the study were Waddell signs, Modified Somatic Perception Questionnaire, Pain Disability Index, and the Minnesota Multiphasic Personality Inventory-2 Restructured Form.Methods
We examined Waddell signs using multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA), receiver operating characteristic analysis, classification accuracy, and relative risk ratios.Results
Multivariate analysis of variance and ANOVA showed a significant association between Waddell signs and somatic amplification. Classification analyses showed increased odds of somatic amplification at a Waddell score of 2 or 3.Conclusions
Our results found significant evidence of an association between Waddell signs and somatic over-reporting. Elevated scores on the Waddell signs (particularly scores higher than 2 and 3) were associated with increased odds of exhibiting somatic over-reporting. 相似文献12.
Background Context
Acute fixed cervical kyphosis may be a rare presentation of conversion disorder, psychogenic dystonia, and potentially as a side effect from typical antipsychotic drugs. Haldol has been associated with acute dystonic reactions. In some cases, rigid deformities ensue. We are reporting a case of a fixed cervical kyphosis after the use of Haldol.Purpose
To present a case of a potential acute dystonic reaction temporally associated with Haldol ingestion leading to fixed cervical kyphosis.Study design
This is a case report.Methods
A patient diagnosed with bipolar disorder presented to the emergency room several times with severe neck pain and stiffness. The neck appeared fixed in flexion with extensive osteophyte formation over a 3-month period.Results
The patient's condition was resolved by a posterior-anterior-posterior surgical approach. It corrected the patient's cervical curvature from 88° to 5°.Conclusions
Acute dystonic reactions have the potential to apply enough pressure on bone to cause rapid osteophyte formation. 相似文献13.
Shujie Wang Jianguo Zhang Ye Tian Jianxiong Shen Yu Zhao Hong Zhao Shugang Li Bin Yu Xisheng Weng 《The spine journal》2017,17(6):777-783
Background Context
Transcranial motor evoked potential (MEP) monitoring has been widely adopted in spine surgery, but so far the useful monitoring data for patients with preoperative spinal deficits (PPSDs) are limited. Originally we thought that they seemed technically more difficult and less reliable in performing the MEP monitoring to PPSDs.Purpose
Our objective was to study (1) the feasibility of MEP monitoring in PPSDs and the (2) the significance of rapid MEP loss.Study Design/Setting
A retrospective case notes study from a prospective patient register was used as the study design.Patient Sample
A total of 332 PPSDs who underwent posterior spine surgery with a reliable MEP monitoring were collected between September 2010 and December 2014.Outcome Measures
Relevant MEP loss was identified as rapid amplitude reduction (more than 80% MEP) associated with high-risk surgical maneuvers or high-risk diagnoses.Method
The muscles with higher strength were used to record the optimal MEP signal. MEP monitoring of these patients was considered to be feasible if reproducible signals had been obtained; moreover, sensitivity, specificity, positive predictive value (PPV), and negative predictive value were computed. The significance of the patients with rapid MEP loss was analyzed.Results
From a total of 332 PPSDs, 27 cases showed significant MEP loss (23 true positive, 4 false positive), and 21 showed new spinal deficits. Invalid MEP baselines were found in 11 paralysis and 6 severely incomplete paraplegia patients, and success rate of reliable MEP was 95.1% in PPSDs. The congenital kyphoscoliosis, tuberculous kyphoscoliosis, and thoracic spinal stenosis are considered high-risk diagnoses to result in MEP loss. The sensitivity of intraoperative MEP monitoring was 100%, the specificity 98.7%, the positive predictive value 85.2%, and the negative predictive value 100%.Conclusions
Intraoperative MEP monitoring is feasible for most of the PPSDs. The rapid MEP loss during high-risk diagnoses and complicated surgical procedures may indicate new spinal deficits. 相似文献14.
Michael K. Urban Kara Fields Sean W. Donegan Jonathan C. Beathe David W. Pinter Oheneba Boachie-Adjei Ronald G. Emerson 《The spine journal》2017,17(12):1889-1896
Background Context
Lidocaine has emerged as a useful adjuvant anesthetic agent for cases requiring intraoperative monitoring of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). A previous retrospective study suggested that lidocaine could be used as a component of propofol-based intravenous anesthesia without adversely affecting MEP or SSEP monitoring, but did not address the effect of the addition of lidocaine on the MEP and SSEP signals of individual patients.Purpose
The purpose of this study was to examine the intrapatient effects of the addition of lidocaine to balanced anesthesia on MEPs and SSEPs during multilevel posterior spinal fusion.Study Design
This is a prospective, two-treatment, two-period crossover randomized controlled trial with a blinded primary outcome assessment.Patient Sample
Forty patients undergoing multilevel posterior spinal fusion were studied.Outcome Measures
The primary outcome measures were MEP voltage thresholds and SSEP amplitudes. Secondary outcome measures included isoflurane concentrations and hemodynamic parameters.Methods
Each participant received two anesthetic treatments (propofol 50?mcg/kg/h and propofol 25?mcg/kg/h+lidocaine 1?mg/kg/h) along with isoflurane, ketamine, and diazepam. In this manner, each patient served as his or her own control. The order of administration of the two treatments was determined randomly.Results
There were no significant within-patient differences between MEP threshold voltages or SSEP amplitudes during the two anesthetic treatments.Conclusions
Lidocaine may be used as a component of balanced anesthesia during multilevel spinal fusions without adversely affecting the monitoring of SSEPs or MEPs in individual patients. 相似文献15.
Takeshi Oichi Hirotaka Chikuda Junichi Ohya Ryo Ohtomo Kojiro Morita Hiroki Matsui Kiyohide Fushimi Sakae Tanaka Hideo Yasunaga 《The spine journal》2017,17(4):531-537
Background Context
There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).Purpose
This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes.Study Design
This is a retrospective matched-pair cohort study.Patient Sample
Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.Outcome Measures
In-hospital mortality and occurrence of postoperative complications.Methods
For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data.Results
Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37–2.22; p<.001).Conclusions
Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication. 相似文献16.
Juan A. Sanchis-Gimeno Susanna Llido David Guede Francisco Martinez-Soriano Jose Ramon Caeiro Esther Blanco-Perez 《The spine journal》2017,17(3):431-434
Background Context
To date, no information about the cortical bone microstructural properties in atlas vertebrae with posterior arch defects has been reported.Purpose
To test if there is an increased cortical bone thickening in atlases with Type A posterior atlas arch defects in an experimental model.Study Design
Micro-computed tomography (CT) study on cadaveric atlas vertebrae.Methods
We analyzed the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry vertebrae with a Type A atlas arch defect and normal control vertebrae.Results
The micro-CT study revealed significant differences in cortical bone thickness (p=.005), cortical volume (p=.003), and medullary volume (p=.009) values between the normal and the Type A vertebrae.Conclusions
Type A congenital atlas arch defects present a cortical bone thickening that may play a protective role against atlas fractures. 相似文献17.
Background Context
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.Purpose
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).Study Design
A randomized controlled trial was performed.Patient Sample
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.Outcome Measures
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.Methods
The LA group (Group L, n=50) received 10?mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10?mL 0.25% bupivacaine+40?mg methylprednisolone at L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.Results
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.Conclusions
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid. 相似文献18.
Jiann-Her Lin Li-Nien Chien Wan-Ling Tsai Li-Ying Chen Yung-Hsiao Chiang Yi-Chen Hsieh 《The spine journal》2017,17(9):1310-1318
Background Context
Whether early vertebroplasty (VP) (within 3 months) offers extra benefit to aged patients older than 70 years with painful vertebral compression fractures (PVCF) in terms of mortality and respiratory-related morbidity remains unknown, given that the elderly is associated with higher surgical risks.Purpose
To elucidate the benefits of an early VP intervention for aged patients with a PVCF by comparing the risks of mortality and respiratory-related morbidity.Study Design
A retrospective propensity score matched cohort.Patient Sample
PVCF patients with an early VP and without an early VP intervention.Outcome Measures
Death, pneumonia, and respiratory failure.Methods
A total of 10,785 PVCF patients who used analgesic injection during admission from 2000 through 2013 were selected from the National Health Insurance Research Database in Taiwan. After matching, there were 1773 VP patients and 5324 non-VP patients included in this study. Conditional Cox proportional hazard models were used to determine the risk of death and respiratory complications.Results
The incidences of death at 1 year of VP and non-VP patients were 0.46 (95% confidence interval [CI]: 0.38–0.56) and 0.63 (95% CI: 0.57–0.70) per 100 person-months, respectively. We observed a hazard ratio (HR) of 1.39 (95% CI: 1.09–1.78, p=.008) when comparing non-VP to VP patients. This phenomenon was seen when estimating the benefits of respiratory failure (HR: 1.46; 95% CI: 1.04–2.05, p=.028).Conclusion
The results showed that VP was associated with lower risks of mortality and respiratory failure in aged patients with a PVCF. VP should be considered a priority for the aged patients with a PVCF requiring admission and analgesics. 相似文献19.
Background Context
Differential alterations have been reported in the local and global cervical muscles in the presence of chronic neck pain (CNP), including the endurance alterations of these muscles. Identifying the involved muscles is crucial to the assessment and rehabilitation of patients with CNP.Purpose
To assess the relationship between clinical endurance test results, pain and disability indices, and ultrasonographic (US) measurements of the neck extensor muscles; to compare the deep and superficial cervical extensor muscle endurance and size of CNP patients with those of asymptomatic subjects and to compare the relationship between local and global extensor endurance with US measures, pain intensity, and disability.Study Design/Setting
Cross-sectional correlational analysis with a case-control design.Patient Sample
Thirty patients with CNP and 30 asymptomatic subjects participated in this study.Outcome Measures
Endurance, thickness, cross-sectional area, and shape ratio of the cervical extensor muscles (splenius capitis [SpCap], semispinalis capitis [SSCap], semispinalis cervicis [SSCer], and multifidus [MF]); pain intensity measured by the visual analog scale (VAS); neck disability index (NDI); correlation between US measures, pain intensity and NDI and extensor endurance; and correlation of US measures with pain intensity and NDI.Methods
The deep and superficial cervical extensor muscle endurance and dimensions were measured via a clinical test and by US, respectively. Participants were asked to hold the neutral chin-tuck position while lying prone. The test would be terminated if the head moved into either flexion or extension, which would yield “global” or “local” extensor muscle endurance, respectively.Results
The CNP patients showed lower global extensor endurance levels than the control participants (p<.05). The US measures of the deep extensor muscles were also smaller in the CNP group (p<.05). There were no significant correlations between extensor endurance test results and US measures in either group except for the SSCap muscle size with local and total endurance (p=.04 for both) of CNP and control participants, respectively. NDI was correlated with SpCap and SSCer muscle thicknesses in a positive and negative manner, respectively (p=.03 for both). There was also a significant correlation between MF size and VAS (p<.05).Conclusions
The findings showed higher levels of global muscle fatigability and smaller size of deep neck extensor muscles in CNP patients. Disability and extensor endurance were found to be associated with extensor muscle size. The results challenge the validity of the clinical extensor muscle endurance test in the differentiation of the deep and superficial extensor muscle endurance and the use of US in the assessment of cervical muscle endurance. Further investigations are needed to judge the superficial and deep muscle endurance in CNP patients. 相似文献20.
Hwee Weng Dennis Hey Eugene Tze-Chun Lau Joel-Louis Lim Denise Ai-Wen Choong Chuen-Seng Tan Gabriel Ka-Po Liu Hee-Kit Wong 《The spine journal》2017,17(3):360-368