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Masashi Uehara Jun Takahashi Shota Ikegami Hiroki Oba Shugo Kuraishi Toshimasa Futatsugi Takashi Takizawa Ryo Munakata Michihiko Koseki Hiroyuki Kato 《Journal of orthopaedic science》2019,24(3):415-419
BackgroundReducing the number of screw insertions while maintaining good clinical outcomes can improve the efficiency and cost-effectiveness of scoliosis surgery. However, the optimal minimum number of pedicle screws remains unclear. This study searched for factors to estimate the fewest number of pedicle screws required between end vertebrae in relation to preoperative main thoracic curve flexibility.MethodsSixty-nine subjects (4 male and 65 female, mean age: 14.8 ± 2.5 years) who underwent skip pedicle screw fixation for Lenke type 1–4 or 6 curves and were followed for at least 1 year were enrolled. Intervention technique was selected according to the size and flexibility of the preoperative main thoracic curve. Surgery-related variables included pedicle screw number, rod material and diameter, and extent of Ponte osteotomy. The effect on postoperative correction angle (i.e., the difference between the preoperative supine position maximum bending and postoperative standing Cobb angles of the main thoracic curve) according to surgical intervention technique was estimated using multiple linear mixed regression models with the preoperative supine position maximum bending correction angle (i.e., the difference between the standing preoperative and supine position maximum bending Cobb angles) as a random effect.ResultsThe preoperative maximum bending correction angle was 8–42° and had a moderate negative correlation with postoperative correction angle (r = ?0.65, P < 0.01). Multivariate analysis revealed a 1.7° (95% CI 0.7–2.6; P < 0.01) correction gain per single-screw insertion and a 1.8° (95% CI 0.5–3.1; P < 0.01) gain per intervertebral level in Ponte osteotomy.ConclusionsThe number of pedicle screws necessary to correct main thoracic adolescent idiopathic scoliosis curves can be estimated by calculating correction gains of 1.7° per pedicle screw and 1.8° per Ponte osteotomy intervertebral level. Based on these results, it may be possible to reduce invasiveness and cost for patients requiring a smaller degree of correction. 相似文献
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Masashi Uehara Jun Takahashi Yohei Akazawa Shugo Kuraishi Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2018,23(2):294-298
Background
As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes.Methods
We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure.Results
Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0 min, and mean blood loss was 1167 g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications.Conclusions
Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time. 相似文献4.
Masashi Uehara Jun Takahashi Shugo Kuraishi Masayuki Shimizu Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2017,22(2):218-223
Study design
A retrospective single-center and single-surgeon study.Objectives
This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS).Summary of background data
At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side. To reduce operation time, blood loss, and cost, we developed skip pedicle screw fixation to achieve correction of AIS using fewer pedicle screws.Methods
We evaluated 62 consecutive patients who had undergone computer-assisted skip pedicle screw fixation from August 2005 to June 2014. All patients were followed up for at least two years. We investigated the clinical results of skip pedicle screw fixation for AIS.Results
The mean number of fused vertebrae was 10.3 ± 2.0, the mean surgical time was 242 ± 78 min, and the mean blood loss volume was 1060 ± 688 ml. The mean Cobb angle of main thoracic (MT) curve two years after surgery improved significantly compared with that before surgery (p < 0.01). The mean correction rate of MT curve immediately after surgery was 62.4 ± 12.4% and correction loss of MT curve at two years after surgery was 1.9 ± 5.8°. The SRS-22 subtotal score two years after surgery improved significantly compared to that before surgery (p < 0.01). Although no patients experienced major complications, eight (12.9%) encountered minor complications (two [3.2%] had massive blood loss [>3000 ml], three [4.8%] had a broken screw, one [1.6%] had a set-screw that dropped out, one [1.6%] experienced deep vein thrombosis, one [1.6%] experienced acute renal failure, and one [1.6%] experienced intercostal neuralgia). Revision surgery was not performed.Conclusions
Subjects with AIS who underwent skip pedicle screw fixation had significantly improved clinical and radiological parameters at two years after surgery, indicating that skip pedicle screw fixation could be used to successfully treat AIS.Level of evidence
Level 4 相似文献5.
Tetsuhiko Mimura Jun Takahashi Shota Ikegami Shugo Kuraishi Masayuki Shimizu Toshimasa Futatsugi Masashi Uehara Hiroki Oba Michihiko Koseki Hiroyuki Kato 《Journal of orthopaedic science》2018,23(1):14-19
Background
It is generally recognized that the main thoracic curve Cobb angle threshold for surgical correction is approximately 50 degrees in patients with adolescent idiopathic scoliosis (AIS). Although AIS with a Cobb angle of <50 degrees is sometimes treated surgically to improve cosmesis, the precise outcomes are unclear. This study analyzed the postoperative results for AIS with a main thoracic curve of 50 degrees.Methods
Thirty-nine consecutive patients with Lenke type 1–2 curves underwent posterior spinal fusion for AIS. These subjects were divided into the <50 degrees of main thoracic curve group (n = 14) and the ≥50 degrees group (n = 25). Clinical and radiographic data were compared.Results
The mean Cobb angle of the main thoracic curve before and at 2 years after surgery for the <50 degrees and ≥50 degrees groups was 44.5 and 60.3 degrees (p < 0.001) and 14.0 and 19.5 degrees (p = 0.016), respectively. Preoperatively, both groups had comparable Scoliosis Research Society-22 (SRS-22) scores (all p > 0.05). Patients with a Cobb angle of <50 degrees displayed significantly milder postoperative pain (4.7 vs. 4.3, p = 0.031), with no remarkable differences in other SRS-22 domain scores. These patients also had a significantly shorter operative time (194 vs. 235 min, p = 0.021) and fused level (9.2 vs. 10.8 vertebrae, p = 0.006) along with similar correction rate (68.1 vs. 65.8%, p = 0.622) and blood loss volume (932 vs. 1009 ml, p = 0.715).Conclusions
Surgical correction of AIS with <50 degrees of main thoracic curve may less invasively achieve results that are comparable with those for AIS with 50 degrees or more, including improvements in self-image. 相似文献6.
Kazuki Fujimoto Kazuhide Inage Sumihisa Orita Masaomi Yamashita Koki Abe Masatsune Yamagata Takeshi Sainoh Tsutomu Akazawa Tomoaki Kinoshita Tetsuharu Nemoto Jiro Hirayama Yasuaki Murata Toshiaki Kotani Yasuchika Aoki Yawara Eguchi Takeshi Sakuma Takahito Aihara Tetsuhiro Ishikawa Seiji Ohtori 《Journal of orthopaedic science》2017,22(4):613-617
Background
Patients with osteoporosis but no evidence of fracture can sometimes report low back pain. However, few studies have evaluated the nature of osteoporotic low back pain in a clinical situation. Therefore, the aim of this study was to examine the nature of osteoporotic low back pain without fracture, and the analgesic effect of minodronic acid hydrate on such pain.Methods
The current study examined 136 patients with osteoporotic low back pain and no lower extremity symptoms. The following factors were evaluated before and after minodronic acid hydrate administration: the nature of osteoporotic low back pain was evaluated using the painDETECT questionnaire, numeric rating scale (NRS) score for low back pain at rest and in motion, bone mineral density (BMD) of the lumbar spine, and the serum concentration of tartrate-resistant acid phosphatase 5b (TRACP-5b) as a bone metabolism marker.Results
A total of 113 patients were enrolled. The painDETECT questionnaire revealed the percentage of patients with nociceptive pain and neuropathic or mixed pain was approximately 85% and 15%, respectively. the average NRS scores for low back pain at rest decreased significantly 2 months after treatment (p = 0.01), while those in motion decreased significantly 1 month after treatment (p = 0.04). The average lumbar spine BMD tended to increase after treatment, but not significantly. On the other hand, the changes in the average serum concentration of TRACP-5b did significantly decrease 1 month after treatment. There was a significant positive correlation between the rate of NRS score improvement for low back pain at rest, and the rate of improvement in serum concentration of TRACP-5b (p < 0.05).Conclusions
Osteoporotic low back pain consisted of 85% nociceptive pain and 15% neuropathic or mixed pain. The pain is strongly related to pain at rest rather than that in motion. 相似文献7.
Mitsuru Yagi Nobuyuki Fujita Eijiro Okada Osahiko Tsuji Narihito Nagoshi Takashi Tsuji Masaya Nakamura Morio Matsumoto Kota Watanabe 《Journal of orthopaedic science》2018,23(4):653-657
Background
Cost-utility analysis of surgery for degenerative lumber spondylolisthesis (DS) is essential for healthcare providers and patients to select appropriate treatment. The purpose of this study was to review the cost-utility of decompression alone versus decompression with fusion for DS.Methods
A retrospective review of 99 consecutive patients who were treated for Meyerding grade 1 DS at two representative spine centers was performed. Patients with significant spinal instability were treated by decompression with fusion (F group, 40 patients); all others were treated by decompression surgery alone (D group, 59 patients). All patients were followed for three years. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct cost for surgery were analyzed, and the incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY).Results
There were no differences between the groups in baseline demographics (D vs. F: age 68 ± 9 vs. 66 ± 7 years; 37% vs. 40% female) or HRQoL (ODI: D, 41 ± 16 vs. F, 46 ± 13%). The F group had a higher initial-surgery cost ($18,992 ± 2932) but lower reoperation frequency (7%) than the D group ($7660 ± 2182 and 12%, respectively). The three-year total direct cost was higher for F than for D ($19,222 ± 3332 vs. $9668 ± 6,168, p = .01). ICER was higher for F at one year ($136,408 ± 187,911 vs. $237,844 ± 212,049, p < .01), but was comparable for F and D at three years (D, $41,923 ± 44,503 vs. F, $51,313 ± 32,849, p = .17).Conclusion
At the three-year follow-up, the two methods had comparable cost-utility. Both methods were cost-effective (defined as an ICER within three times the per-capita gross domestic product). 相似文献8.
Daisuke Tateiwa Kazuya Oshima Takaaki Nakai Yoshinori Imura Takaaki Tanaka Hidetatsu Outani Hironari Tamiya Nobuhito Araki Norifumi Naka 《Journal of orthopaedic science》2019,24(2):347-352
Background
The development of effective chemotherapy regimens and molecular targeting agents are improving the overall survival rates in patients with cancer. However, patients who are non-ambulatory due to metastatic epidural spinal cord compression (MESCC) may be assessed as unable to tolerate chemotherapy secondary to poor performance status. This means that the ambulatory status of patients with cancer might be significant for survival time.Methods
We investigated the functional outcomes and factors influencing overall survival in 31 patients who were non-ambulatory due to MESCC and underwent decompression surgery. The functional outcome was determined by the Frankel grading system.Result
Twenty-one patients (68%) improved by at least 1 Frankel grade; 17 patients (55%) became ambulatory postoperatively. Most of postoperatively ambulatory patients could undergo postoperative chemotherapy (14/17, 82%). On the other hand, only a few postoperatively non-ambulatory patients could undergo postoperative chemotherapy (2/15, 13%). We observed a complication rate of 35.5% with specific complications including wound infection, pneumonia, and deep vein thrombosis/pulmonary embolus. The median survival duration was 7.0 months. Factors that significantly affected the overall survival in univariate analyses were revised Tokuhashi score (RTS) ≥ 4, postoperative chemotherapy, ambulatory status, and complications (RTS ≥ 4, P < 0.05; postoperative chemotherapy, P < 0.001; ambulatory status, P < 0.001; complications, P < 0.01).Conclusions
Decompression surgery for patients who are non-ambulatory due to MESCC directly contributes to functional outcomes and may indirectly contribute to overall survival. If non-ambulatory patients who are assessed as unable to tolerate chemotherapy due to poor performance status regain the ability to walk by decompression surgery, they will have a chance to receive postoperative chemotherapy, thereby increasing their chances of prolonging survival. However, postoperative complications may shorten their survival; therefore, we should carefully consider the surgical indications. RTS is useful for judging the surgical indication. 相似文献9.
Ko Matsudaira Hiroyuki Oka Norimasa Kikuchi Yuri Haga Takayuki Sawada Sakae Tanaka 《Journal of orthopaedic science》2017,22(2):224-229
Background
The STarT Back Tool classifies patients into low-, medium-, or high-risk groups according to risk for chronic low back pain. The Japanese version of the STarT Back Tool (STarT-J) has been translated and psychometrically validated. The present analysis investigated the predictive ability of the STarT-J.Methods
Baseline data were collected through an online survey conducted with Japanese patients with low back pain. Long-term outcomes were assessed in a 6-month follow-up survey. Clinical outcomes at 6 months were evaluated with a pain numerical rating scale, the Roland–Morris Disability Questionnaire, and the EuroQol 5 Dimension. Differences in these scores among the three STarT-J risk groups were analyzed. Participants' perceived changes in low back pain and overall health status were examined to determine associations between the chronicity of low back pain at 6 months and STarT-J risk groups.Results
Data of 1228 volunteers who responded to the baseline and follow-up surveys were included in this analysis. Mean ± standard deviation (SD) scores for the pain numerical rating scale and the Roland–Morris Disability Questionnaire were highest in the high-risk group (5.6 ± 1.9 and 9.6 ± 7.5) and lowest in the low-risk group (3.9 ± 1.6 and 2.1 ± 3.5). Mean ± SD EuroQol 5 Dimension index scores were lowest in the high-risk group (0.66 ± 0.20) and highest in the low-risk group (0.86 ± 0.14). A small percentage of high-risk patients (5.3%) perceived improvement in low back pain at the 6-month follow-up.Conclusions
The STarT-J predicted 6-month pain and disability outcomes. The STarT-J is an easy-to-use tool to screen for patients who are more likely to have chronic low back pain, and may be useful to initiate stratified care in primary care settings. 相似文献10.
Ryoji Tominaga Miho Sekiguchi Koji Yonemoto Tatsuyuki Kakuma Shin-ichi Konno 《Journal of orthopaedic science》2018,23(4):643-648
Background
The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was developed in 2007, including the five domains of Pain-related disorder, Lumbar spine dysfunction, Gait disturbance, Social life disturbance, and Psychological disorder. It is used by physicians to evaluate treatment efficacy by comparing scores before and after treatment. However, the JOABPEQ does not allow evaluation of the severity of a patient's condition compared to the general population at a single time point. Given the unavailability of a standard measurement of back pain, we sought to establish reference scores and interquartile ranges using data obtained from a multicenter, cross-sectional survey taken in Japanese primary care settings.Methods
The Lumbar Spinal Stenosis Diagnosis Support Tool project was conducted from 2011 to 2012 in 1657 hospitals in Japan to investigate the establishment of reference scores using JOABPEQ. Patients aged ≥ 20 years undergoing medical examinations by either non-orthopaedic primary care physicians or general orthopedists were considered for enrollment.Results
A total of 10,651 consecutive low back pain patients (5331 men, 5320 women, 18 subjects with missing sex data) who had undergone a medical examination were included. Reference scores and interquartile ranges for each of the five domains of the JOABPEQ according to age and sex were recorded. The median score and interquartile range are the same in the domain of Pain-related disorder in all ages and sexes. The reference scores for Gait disturbance, Social life disturbance and Psychological disorder declined with increasing age in both age- and sex-stratified groups, while there was some different trend in Lumbar spine dysfunction between men and women.Conclusion
Reference scores and interquartile ranges for JOABPEQ were generated based on the data from the examination data. These provide a measurement standard to assess patient perceptions of low back pain at any time point during evaluation or therapy. 相似文献11.
Tomoko Tetsunaga Tomonori Tetsunaga Keiichiro Nishida Masato Tanaka Yoshihisa Sugimoto Tomoyuki Takigawa Yoshitaka Takei Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(2):230-236
Introduction
Denosumab specifically inhibits the receptor activator for nuclear factor-kappa B ligand (RANKL), and prevents osteoporotic fractures. Several reports have analyzed the effects of denosumab and alendronate alone on bone mineral density (BMD) or reduction of fracture risk. The objective of this study was to analyze the effects of antiresorptive osteoporosis pharmacotherapy on pain relief in patients with fresh vertebral fracture.Methods
This retrospective, single-center study included 80 patients (10 males, 70 females) with fresh osteoporotic vertebral fractures treated using denosumab at a dose of 60 mg subcutaneously every 6 months (40 patients) or alendronate at a dose of 35 mg orally every week (40 patients) for 6 months in our hospital. The mean age of subjects was 77 years (range, 55–92 years). The primary outcome was duration of back pain. Secondary outcomes included changes in BMD, serum type 1 collagen cross-linked N-telopeptide (NTX), and serum N-terminal propeptide of type 1 collagen (P1NP) from baseline to 6 months. Pain catastrophizing due to back pain was assessed using the Pain Catastrophizing Scale (PCS). The incidences of further vertebral fracture and adverse events were also assessed.Results
Pain relief was obtained at a mean of 3.3 weeks with denosumab and 5.4 weeks with alendronate. Pain relief was achieved significantly earlier with denosumab than with alendronate. At 6 months, change in BMD was higher with denosumab (6.1%) than with alendronate (0.8%). No significant differences in changes in NTX and P1NP were observed between groups. Scores for PCS were significantly lower for denosumab than for alendronate. The incidence of further vertebral fractures was 5% with denosumab and 10% with alendronate. Adverse event rates were similar between groups.Conclusions
Denosumab enabled earlier pain relief than alendronate and avoided catastrophizing in patients with osteoporotic vertebral fractures after 6 months of treatment. 相似文献12.
Koji Yamasaki Masahiro Hoshino Keita Omori Hidetoshi Igarashi Takashi Tsuruta Hiroyuki Miyakata Yasuhiro Nemoto Hiromi Matsuzaki Takanori Iriuchishima 《Journal of orthopaedic science》2017,22(6):1021-1025
Background
Spinal surgery is classified as a moderate risk for DVT. The occurrence of DVT after various spinal surgical procedures was reviewed retrospectively, and the perioperative risk factors in the high-risk group were identified. In addition, the administration of the factor Xa inhibitor to DVT subjects with unstable thrombosis was evaluated to reveal its effectiveness in the prevention of PTE and postoperative complications.Methods
This study included 588 subjects who underwent lumbar spine surgery. The patient population consisted of the following four groups: the fracture group (F group), the laminectomy group (La group), the TLIF group (T group), and the long fusion group (Lo group). Bilateral lower limb venous ultrasonography was performed on the day before surgery, the day after surgery, and one week after surgery. The incidence of DVT was determined for each group and potential risk factors were evaluated in the group with the highest incidence of DVT. Subjects with DVT who had unstable thrombosis received anticoagulant therapy (factor Xa inhibitor) and their treatment results were assessed.Results
The overall incidence of DVT was 32.3% (190/588). A significantly high incidence of DVT was observed in the Lo group (54.3%; 75/138). Logistic regression and ROC analysis of potential risk factors in the Lo group identified a D-dimer value of 19.5 ug/ml at one week postoperatively as a risk factor of DVT (p = 0.02; odds ratio, 4.09; 95% CI, 2.82–7.88). Overall, 15.8% of subjects (30/190) received anticoagulant therapy. These subjects experienced neither PTE nor epidural hematoma. A follow-up ultrasonography performed at three weeks postoperatively detected the disappearance/resolution of DVT in 86.7% of these subjects (26/30).Conclusion
The incidence of DVT varied according to the invasiveness of the procedure. Successful management of DVT hinges on preoperative risk management involving prophylactic treatment and early diagnosis, in order to avoid PTE and other complications. 相似文献13.
Tomoko Tetsunaga Tomonori Tetsunaga Keiichiro Nishida Masato Tanaka Yoshihisa Sugimoto Tomoyuki Takigawa Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(3):554-559
Background
Although a multidisciplinary approach is often recommended to treat intractable pain, this approach does not completely prevent uncontrolled pain in some patients. The aim of this retrospective study was to investigate the exacerbating factors of prolonged, intractable pain among patients being treated at a pain liaison clinic.Methods
The participants of this study were 94 outpatients (32 men, 62 women) with chronic intractable pain who visited our hospital between April 2013 and February 2015. Demographic and clinical information was obtained from all patients at baseline. Experts in various fields, including anesthesia, orthopedic surgery, psychiatry, physical therapy, and nursing, were involved in the treatment procedures. All patients were assessed before and after a 6-month treatment period using the following measures: the Numeric Rating Scale (NRS); the Pain Catastrophizing Scale (PCS); the Hospital Anxiety and Depression Scale (HADS); the Pain Disability Assessment Scale (PDAS); and the Oswestry Disability Index (ODI). All participants were then divided into two groups based on their self-reported pain after treatment: a pain relief group (n = 70) and a prolonged pain group (n = 24). The exacerbating factors of prolonged pain after treatment in the pain liaison outpatient clinic were analyzed using univariate and multiple logistic regression analysis.Results
A significant improvement in NRS scores was observed after the 6-month follow-up period. After treatment, 24 (25.5%) of the 94 patients reported having prolonged pain. Significant improvements were seen in the PCS, PDAS, and ODI scores in the pain relief group, and in the HADS depression scores in the prolonged pain group. On univariate and multiple regression analysis, HADS depression scores were identified as a factor related to prolonged pain after treatment.Conclusions
The results of the present study suggest that severe depression at the initial visit to the liaison outpatient clinic was an exacerbating factor for prolonged pain after treatment. 相似文献14.
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Terumasa Ikeda Hiroshi Miyamoto Kazuki Hashimoto Masao Akagi 《Journal of orthopaedic science》2017,22(2):197-200
Background
DVT is one of the major postoperative complications of joint replacement surgery of the lower extremity which can cause catastrophic complications such as pulmonary embolism. However, little is known about the incidence of DVT after spine surgery. The purpose of this study was to examine predictable factors of DVT after spine surgery.Methods
This study included 194 patients who underwent spine surgery (104 males, 90 females, mean age 65.7 years). Postoperative DVT was detected using duplex ultrasonography (DUS). Age, sex, BMI, operation time, amount of bleeding, preoperative ambulatory status, usage of instrumentation, and preoperative serum levels of D-dimer were compared between the DVT(+) and DVT(?) groups to establish predictors for postoperative DVT. Cut-off value of the preoperative level of D-dimer was calculated using ROC analysis.Results
Postoperative DVT was detected in 57 patients (29.4%). No patients showed clinical signs of DVT or pulmonary embolism. Sex, age, BMI, preoperative non-ambulatory status, and preoperative levels of D-dimer were significantly different between the DVT(+) and DVT(?) groups. However, age and BMI was not significantly different factor in logistic regression analysis. Cut-off value of preoperative D-dimer was 1.4 μg/ml.Conclusion
It was suggested that perioperative application of DUS for detecting DVT in the lower extremities should be performed on patients undergoing spine surgery who are female, non-ambulatory, and with higher preoperative D-dimer serum level. 相似文献16.
Kazuyoshi Kobayashi Kei Ando Kenyu Ito Mikito Tsushima Akiyuki Matsumoto Masayoshi Morozumi Satoshi Tanaka Masaaki Machino Naoki Ishiguro Shiro Imagama 《Journal of orthopaedic science》2018,23(2):266-272
Background
Postoperative cerebrospinal fluid (CSF) leakage is a major clinical problem, and prevention of CSF leakage at the surgical site is an important issue. The goal of the study was to evaluate the efficacy of intraoperative lumbar subarachnoid drainage (LSAD) for prevention of CSF leakage after spinal cord tumor resection.Methods
The subjects were 97 patients with a cervical or thoracic primary intradural spinal cord tumor who underwent surgery at our hospital. A LSAD catheter was placed in the lumbar thecal sac before incision and left in place for several days postoperatively. Age, tumor level, number of laminectomy levels, operation time, estimated blood loss (EBL) intraoperatively, use of artificial dura mater, white blood cell (WBC) counts and C-reactive protein (CRP) levels on postoperative days (PODs) 3 and 10, subcutaneous CSF accumulation at the operation site, and postoperative complications were examined retrospectively.Results
LSAD of CSF was performed in 35 patients. In this group, the drainage catheter was left in place for an average of 4.9 (range 3–8) days. Use of artificial dura mater was significantly higher and CRP on POD 10 was significantly lower in the drainage group. Subcutaneous accumulation of CSF due to leakage was significantly higher in patients with cervical lesions than in those with thoracic lesions. In cases in which artificial dura mater was used, CSF leakage occurred at a significantly lower rate in the drainage group. Without use of an artificial dura mater, CSF leakage did not differ significantly between the two groups.Conclusion
Lumbar subarachnoid CSF drainage was associated with a significant decrease in postoperative CRP. In cases in which artificial dura mater was used and in surgery for a cervical lesion, drainage was useful to prevent subcutaneous CSF accumulation. 相似文献17.
Yusuke Sakai Shota Takenaka Yohei Matsuo Hiroyasu Fujiwara Hirotsugu Honda Takahiro Makino Takashi Kaito 《Journal of orthopaedic science》2018,23(5):734-738
Object
This study aims to clarify the clinical potential of Hounsfield unit (HU), measured on computed tomography (CT) images, as a predictor of pedicle screw (PS) loosening, compared to bone mineral density (BMD).Methods
A total of 206 screws in 52 patients (21 men and 31 women; mean age 68.2 years) were analyzed retrospectively. The screws were classified into two groups depending on their screw loosening status on 3-month follow-up CT (loosening screw group vs. non-loosening screw group). Preoperative HU of the trajectory was evaluated by superimposing preoperative and postoperative CT images using three-dimensional image analysis software. Age, sex, body mass index, screw size, BMD of lumbar, and HU of screw trajectory were analyzed in association with screw loosening. Multivariate logistic regression analysis was performed, and the thresholds for PS loosening risk factors were evaluated using a continuous numerical variable and receiver operating characteristic (ROC) curve analyses. The area under the curve (AUC) was used to determine the diagnostic performance, and values > 0.75 were considered to represent good performance.Results
The loosening screw group contained 24 screws (12%). Multivariate analysis revealed that the significant independent risk factors were not BMD but male sex [P = 0.028; odds ratio (OR) 2.852, 95% confidence interval (CI) 1.120–7.258] and HU of screw trajectory (P = 0.006; OR 0.989, 95% CI 0.980–0.997). ROC curve analysis demonstrated that the AUC for HU of screw trajectory for women was 0.880 (95% CI 0.798–0.961). The cutoff value was 153.5. AUC for men was 0.635 (95% CI 0.449–0.821), which was not considered to be a good performance.Conclusions
Low HU of screw trajectories was identified as a risk factor of PS loosening for women. For female patients with low HU, additional augmentation is recommended to prevent PS loosening. 相似文献18.
Shunsuke Fujibayashi Bungo Otsuki Hiroaki Kimura Shimei Tanida Kazutaka Masamoto Shuichi Matsuda 《Journal of orthopaedic science》2017,22(3):420-424
Background
Performing the minimally invasive lateral lumbar interbody fusion (LIF), such as the extreme lateral interbody fusion (XLIF) and oblique lateral interbody fusion (OLIF), through a retroperitoneal approach has become increasingly popular. Although urological injury is a major complication of LIF, the anatomical location of the ureter and its risk of injury have not been assessed. The purpose of this study was to evaluate the efficacy of dual-phase contrast-enhanced computed tomography for assessing the location of the ureter and risk of its injury in consecutive LIF cases.Methods
27 cases (12 men and 15 women) were enrolled in the study. Dual-phase contrast-enhanced CT was performed preoperatively, and the risk of ureteral injury was assessed. The location of the ureter was classified using the psoas muscle and vertebral body as reference structures for OLIF and XLIF procedures, respectively. During the OLIF procedures, the location of the ureter was additionally assessed with direct vision and manual palpation in all cases. Simultaneously, potential vascular anomalies were assessed with both 3D and axial images of CT.Results
A total of 125 among 162 ureters, excluding 13 with insufficient enhancement and 24 (44.4%) within the kidney at the L2–L3 level, were assessed preoperatively; 113 ureters (90.4%) were classified as anatomically close to the surgical corridor for OLIF, and 20 ureters (16.0%) as having a potential risk of injury during XLIF. In one case, OLIF was converted to a conventional posterior procedure because of a vascular anomaly. Intraoperative findings showed that ureters moved anteriorly with the peritoneum in all cases, as assessed by manual palpation under direct vision.Conclusions
Dual-phase contrast-enhanced CT is useful in assessing the location of the ureter, kidney, and vascular structures simultaneously. Both OLIF and XLIF have a potential risk of urological injury. 相似文献19.
Yoshihiro Hagiwara Takuya Sekiguchi Yumi Sugawara Yutaka Yabe Masashi Koide Nobuyuki Itaya Shinichiro Yoshida Yasuhito Sogi Masahiro Tsuchiya Ichiro Tsuji Eiji Itoi 《Journal of orthopaedic science》2018,23(2):334-340
Background
The Great East Japan Earthquake (GEJE) and Tsunami devastated the northeastern coast of Japan on March 11, 2011. This study aimed to determine whether sociopsychological factors, such as sleep disturbance and psychological distress, influenced new-onset subjective knee pain in survivors during the post-disaster phase of the GEJE.Methods
From November 2012 to February 2013 (2 years after the GEJE) and from November 2013 to February 2014 (3 years after the GEJE), survivors (≥18 years) completed self-reported questionnaires. A total of 1470 survivors responded to the questionnaires and were included in this study. New-onset subjective knee pain was defined as knee pain by encircled response absent at 2 years but present at 3 years after the GEJE. Two years after the GEJE, ≥10/24 points on the Kessler Psychological Distress Scale, and ≥6/24 points on the Athens Insomnia Scale defined the presence of psychological distress and sleep disturbance, respectively. Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between new-onset subjective knee pain and psychological distress or sleep disturbance.Results
Among the participants, 10.9% (160/1470) reported experiencing new-onset subjective knee pain. Sleep disturbance was significantly associated with new-onset subjective knee pain (OR, 1.57, 95% CI, 1.08–2.29, P = 0.017); however, psychological distress was not (OR, 1.07, 95% CI, 0.65–1.78, P = 0.80).Conclusions
This is the first study to indicate an association between sleep disturbance and new-onset subjective knee pain among survivors of the GEJE. 247/300. 相似文献20.
Carlos Torrens Fernando Santana Raquel Marí Lluis Puig Albert Alier 《Journal of orthopaedic science》2017,22(5):858-861