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Guo H, Yang L, Liu J, Yu X, Chen L, Huang Y. Prognostic Nutritional Index and the Risk of Postoperative Complications After Spine Surgery: A Meta-Analysis. World Neurosurg 2024; 185:e572-e581. [PMID: 38382761 DOI: 10.1016/j.wneu.2024.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND A low prognostic nutritional index (PNI) may reflect malnutrition, which has been associated with poor prognosis in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to investigate the association between preoperative PNI and risk of postoperative complications in adult patients after spine surgery. METHODS An extensive search was conducted on PubMed, Embase, and Web of Science to identify relevant cohort studies. Random-effects models were employed to combine the findings, taking into account the potential influence of heterogeneity. RESULTS Ten cohort studies involving 3,249 patients receiving spine surgeries were included. Pooled results showed that a low preoperative prognostic nutritional index (PNI) was associated with an increased risk of overall postoperative complications in these patients (odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.42 to 2.34, P < 0.001; I2 = 49%). Specifically, a preoperative malnutrition as evidenced by a low PNI was associated with a higher incidence of postoperative delirium (OR: 2.36, 95% CI: 1.52 to 3.66, P < 0.001; I2 = 38%) and surgical site infection (OR: 1.41, 95% CI: 1.15 to 1.73, P = 0.001; I2 = 0%). Sensitivity analyses by excluding one study at a time did not significantly change the results (P all <0.05). CONCLUSIONS A preoperative low prognostic nutritional index (PNI) may be a risk factor of increased incidence of overall postoperative complications, postoperative delirium, and surgical site infection in adult patients after spine surgeries.
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Affiliation(s)
- Hubing Guo
- The First Department of Orthopaedic Surgery, The First Hospital of Tianshui, Tianshui, P.R. China.
| | - Lingxia Yang
- Department of Dermatology, The First Hospital of Tianshui, Tianshui, P.R. China
| | - Jin Liu
- The First Department of Orthopaedic Surgery, The First Hospital of Tianshui, Tianshui, P.R. China
| | - Xinfu Yu
- The First Department of Orthopaedic Surgery, The First Hospital of Tianshui, Tianshui, P.R. China
| | - Liqi Chen
- The First Department of Orthopaedic Surgery, The First Hospital of Tianshui, Tianshui, P.R. China
| | - Yufeng Huang
- The First Department of Orthopaedic Surgery, The First Hospital of Tianshui, Tianshui, P.R. China
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Bae Y, Yon DK, Lee SW. Cerebrovascular Complications in Spinal Fusion Surgery: A Nationwide 8-year Follow-up Study in South Korea. Clin Nurs Res 2024; 33:220-230. [PMID: 38511266 DOI: 10.1177/10547738241240801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This retrospective study investigated the long-term incidence and risk of postoperative complications following spinal fusion. This study included 640,366 participants from a National Health Examination cohort in the Republic of Korea. Among them, 11,699 individuals underwent spinal fusion, and 56,667 individuals who underwent non-fusion spinal procedures served as controls. Propensity score matching was used to account for patient characteristics including demographic factors, comorbidities, and other relevant variables. The participants were followed for 8 years to assess the occurrence of cerebrovascular disease (CVD), hemorrhagic infarction (HA), ischemic infarction (II), occlusion and stenosis, and ischemic heart disease (IHD). The incidence rates of CVD and IHD were found to be 27.58 and 31.45 per 1,000 person-years in the spinal fusion group compared to 18.68 and 25.73 per 1,000 person-years in the control group (p < .001), respectively. Patients who underwent spinal fusion had a higher risk of CVD, HA, and IHD than those in the control group (all p < .001). In the subgroup analysis, thoracolumbar and noncervical spinal fusion were associated with a higher risk of CVD, II, and IHD (all p < .005). Patients undergoing thoracolumbar fusion may have an increased association with CVD, II in cerebral arteries, and IHD. This suggests a need for careful consideration of vascular risks in such patient populations.
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Affiliation(s)
- Youngoh Bae
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
- Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Dong Keon Yon
- Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
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Jiang SH, Deysher D, Adachi K, Bhaskara M, Almadidy Z, Sadeh M, Mehta AI, Chaudhry NS. Surgical Outcomes in Octogenarians with Central Cord Syndrome: A Propensity-Score Matched Analysis. World Neurosurg 2024; 184:e228-e236. [PMID: 38266996 DOI: 10.1016/j.wneu.2024.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Central cord syndrome (CCS) is a traumatic cervical spine injury that is treated with surgical decompression. In octogenarians (80-89), surgeons often opt for conservative management instead due to fears of postoperative complications and prolonged recovery times. This study aims to assess the in-hospital complications and outcomes in octogenarians undergoing surgery compared to those undergoing nonsurgical management for CCS. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for octogenarians with CCS. Patients who received surgical fusion or decompression were divided into the surgery group and the remaining into the nonsurgical group. The surgery group was sampled and propensity score matched with the non-surgery group. Student t tests and Pearson χ2 tests were used to test for group differences. RESULTS A total of 759 octogenarians with CCS were identified. Following sampling and propensity score matching, 225 patients were identified in each group. The surgery group experienced longer intensive care unit (6.8 days vs. 3.21 days, P < 0.001) and hospital (13.79 days vs. 7.8 days, P < 0.001) lengths of stay and higher rates of deep vein thrombosis (4.89% vs. 0.44%, P = 0.02) and ventilator-associated pneumonia (4% vs. 0%, P = 0.02). Patients did not otherwise differ in mortality rate, other hospital complications, and discharge disposition. CONCLUSIONS Octogenarians undergoing surgery for CCS experience longer length of stay and complications consistent with prolonged hospitalization but otherwise have similar mortality, hospital complications, and discharge disposition compared to non-surgical treatment. Given the relative lack of short-term drawbacks, surgery should be considered first-line management when the long-term benefits are substantive.
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Affiliation(s)
- Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
| | - Daniel Deysher
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Kaho Adachi
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Mounika Bhaskara
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Zayed Almadidy
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Morteza Sadeh
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA; Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery and Brain Repair, University of South Florida, Lakeland, Florida, USA
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Yang Z, Sun Y, Deng C, Dong X, Hao L. Comparative efficacy of robotic-assisted and freehand techniques for pedicle screw placement in spinal disorders: a meta-analysis and systematic review. J Robot Surg 2024; 18:121. [PMID: 38492043 DOI: 10.1007/s11701-024-01874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
The efficacy and safety of robotic-assisted pedicle screw placement compared to traditional fluoroscopy-guided techniques are of great interest in the field of spinal surgery. This systematic review and meta-analysis aimed to compare the outcomes of these two methods in patients with spinal diseases. Following the PRISMA guidelines, we conducted a systematic search across PubMed, Embase, Web of Science, and Cochrane Library. We included randomized controlled trials comparing robotic-assisted and fluoroscopy-guided pedicle screw placement in patients with spinal diseases. Outcome measures included the accuracy of pedicle screw placement, postoperative complication rates, intraoperative radiation exposure time, and duration of surgery. Data were analyzed using Stata software. Our analysis included 12 studies. It revealed significantly higher accuracy in pedicle screw placement with robotic assistance (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 2.20-3.64, P < 0.01). Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were similar between the two techniques (OR = 0.72, 95% CI = 0.31 to 1.68, P = 0.56 for complication rates; weighted mean difference [WMD] = - 0.13, 95% CI = - 0.93 to 0.68, P = 0.86 for radiation exposure time; WMD = 0.30, 95% CI = - 0.06 to 0.66, P = 0.06 for duration of surgery). Robotic-assisted pedicle screw placement offers superior placement accuracy compared to fluoroscopy-guided techniques. Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were comparable for both methods. Future studies should explore the potential for fewer complications with the robotic-assisted approach as suggested by the lower point estimate.
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Affiliation(s)
- Zhanhua Yang
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Yuhang Sun
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Changcui Deng
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
| | - Xiuhui Dong
- Department of Dermatology, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Liansheng Hao
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
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Marek RJ, Le JT, Hapenciuc G, Philip MA, Chiu J, Block AR, Ben-Porath YS. Incremental Contribution of the Minnesota Multiphasic Personality Inventory - 3 to Predicting One-Year Postoperative Spinal Cord Surgery/Spinal Cord Stimulation Outcomes. J Clin Psychol Med Settings 2024; 31:77-90. [PMID: 37642803 DOI: 10.1007/s10880-023-09971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Pre-surgical psychological assessments are becoming common in the United States and are recommended or required prior to surgical/spinal cord stimulator intervention for chronic back pain. Psychological testing is often recommended for these evaluations and the various versions of the Minnesota Multiphasic Personality Inventory (MMPI) have demonstrated utility for predicting outcomes in this setting. This investigation sought to extend that literature with the newest version of the MMPI, the MMPI-3. The sample comprised of 909 patients (50.5% men, 49.5% women) who consented to participating in an outcome study and took the MMPI-3 along with other self-report measures of pain, functional disability, and emotional functioning prior to surgery as part of their pre-surgical psychological assessment. Self-report measures of pain, functional disability, and emotional functioning were administered again one-year following the intervention. MMPI-3 scale scores accounted for up to 9% of additional variance in the outcomes after controlling for pre-surgical measures. Measures of emotional/internalizing dysfunction, somatic dysfunction, and, to a lesser extent, behavioral/externalizing dysfunction contributed the most to the prediction of poorer outcomes.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, 1905 University Ave, Huntsville, TX, 77340, USA.
| | - Janet T Le
- Department of Primary Care & Clinical Medicine, Sam Houston State University, Conroe, TX, USA
| | - Gabriel Hapenciuc
- Department of Primary Care & Clinical Medicine, Sam Houston State University, Conroe, TX, USA
| | - Michelle A Philip
- Department of Primary Care & Clinical Medicine, Sam Houston State University, Conroe, TX, USA
| | - Josephine Chiu
- Department of Primary Care & Clinical Medicine, Sam Houston State University, Conroe, TX, USA
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Porche K, Maciel CB, Lucke-Wold B, Mehkri Y, Murtaza Y, Goutnik M, Robicsek SA, Busl KM. Pre-operative prediction of post-operative urinary retention in lumbar surgery: a prospective validation of machine learning model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3868-3874. [PMID: 37768336 DOI: 10.1007/s00586-023-07954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Predicting urinary retention is difficult. The aim of this study is to prospectively validate a previously developed model using machine learning techniques. METHODS Patients were recruited from pre-operative clinic. Prediction of urinary retention was completed pre-operatively by 4 individuals and compared to ground truth POUR outcomes. Inter-rater reliability was calculated with intercorrelation coefficient (2,1). RESULTS 171 patients were included with age 63 ± 14 years, 58.5% (100/171) male, BMI 30.4 ± 5.9 kg/m2, American Society of Anesthesiologists class 2.6 ± 0.5, 1.7 ± 1.0 levels, 56% (96/171) fusions. The observed rate of POUR was 25.7%. The model's performance was found to be 0.663 (0.567-0.759). With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, the following predictive power was achieved: specificity 90.6%, sensitivity 22.7%, negative predictive value 77.2%, positive predictive value 45.5%, and accuracy 73.1%. Intercorrelation coefficient for the regression aspect of the model was found to be 0.889 and intercorrelation coefficient for the neural network aspect of the model was found to be 0.874. CONCLUSIONS This prospective study confirms performance of the prediction model for POUR developed with retrospective data, showing great correlation. This supports the use of machine learning techniques in the prediction of postoperative complications such as urinary retention.
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Affiliation(s)
- Ken Porche
- Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32610, USA.
| | - Carolina B Maciel
- Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32610, USA
| | - Yusuf Mehkri
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yasmeen Murtaza
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Goutnik
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Steven A Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Katharina M Busl
- Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32610, USA
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Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management. Cancers (Basel) 2023; 15:cancers15061796. [PMID: 36980681 PMCID: PMC10046378 DOI: 10.3390/cancers15061796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.
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Development and validation of nomograms predicting overall and cancer-specific survival for non-metastatic primary malignant bone tumor of spine patients. Sci Rep 2023; 13:3503. [PMID: 36859465 PMCID: PMC9977926 DOI: 10.1038/s41598-023-30509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
At present, no study has established a survival prediction model for non-metastatic primary malignant bone tumors of the spine (PMBS) patients. The clinical features and prognostic limitations of PMBS patients still require further exploration. Data on patients with non-metastatic PBMS from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate regression analysis using Cox, Best-subset and Lasso regression methods was performed to identify the best combination of independent predictors. Then two nomograms were structured based on these factors for overall survival (OS) and cancer-specific survival (CSS). The accuracy and applicability of the nomograms were assessed by area under the curve (AUC) values, calibration curves and decision curve analysis (DCA). Results: The C-index indicated that the nomograms of OS (C-index 0.753) and CSS (C-index 0.812) had good discriminative power. The calibration curve displays a great match between the model's predictions and actual observations. DCA curves show our models for OS (range: 0.09-0.741) and CSS (range: 0.075-0.580) have clinical value within a specific threshold probability range compared with the two extreme cases. Two nomograms and web-based survival calculators based on established clinical characteristics was developed for OS and CSS. These can provide a reference for clinicians to formulate treatment plans for patients.
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Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemée JM. Robotics in spine surgery: systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:447-456. [PMID: 35849162 DOI: 10.1007/s00264-022-05508-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
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Affiliation(s)
- Ignacio Barrio Lopez
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France
| | - Ahmed Benzakour
- Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France
| | - Andreas Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France. .,INSERM CRCI2NA Team 5, GLIAD, Angers, France.
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Henson P, Shuman WH, Li AY, Ali M, Kalagara R, Hrabarchuk E, Schupper AJ, Steinberger J, Gal JS, Choudhri TF. Seasonal Effects on Postoperative Complications After Spinal Surgery: A National Database Analysis. World Neurosurg 2023; 170:e455-e466. [PMID: 36375802 DOI: 10.1016/j.wneu.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the role of seasonality on postoperative complications after spinal surgery. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018. Current Procedural Terminology codes were used to identify the following procedures: posterior cervical decompression and fusion, cervical laminoplasty, posterior lumbar fusion, lumbar laminectomy, and spinal deformity surgery. The database was queried for deep vein thrombosis (DVT), pulmonary embolism, pneumonia, sepsis, septic shock, Clostridium difficile infection, stroke, cardiac arrest, myocardial infarction, urinary tract infection (UTI), and early unplanned hospital readmission (readmission). Warm season was defined as April-September, whereas cold season was defined as October-March. Statistical analysis included computing overall complication rates and comparison between seasons using univariate analysis and multivariable logistic regression. RESULTS A total of 208,291 individuals underwent spinal surgery from 2011 to 2018. There was a statistically significant increase in UTI (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.07-1.26; P = 0.0002) and readmission (OR, 1.06; 95% CI, 1.02-1.11, P = 0.007) in the warm season compared with the cold season. An investigation into the July effect showed increases in DVT (OR, 1.24; 95% CI, 1.03-1.48; P = 0.020) and thromboembolic events (OR 1.17; 95% CI, 1.01-1.35; P = 0.032) in July-September compared with the preceding 3 months. CONCLUSIONS The results showed a higher incidence of UTI and readmission among spine surgery patients in the warm season and a higher incidence of DVT and thromboembolic events from July to September. In both cases, the effect of seasonality is statistically significant, but the absolute difference is small and may not suggest policy changes.
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Affiliation(s)
- Philip Henson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA.
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Alex J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jonathan S Gal
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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Perioperative transcutaneous electrical acupoint stimulation (pTEAS) in pain management in major spinal surgery patients. BMC Anesthesiol 2022; 22:342. [PMID: 36348477 PMCID: PMC9641754 DOI: 10.1186/s12871-022-01875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lumbar disc herniation is seen in 5–15% of patients with lumbar back pain and is the most common spine disorder demanding surgical correction. Spinal surgery is one of the most effective management for these patients. However, current surgical techniques still present complications such as chronic pain in 10–40% of all patients who underwent lumbar surgery, which has a significant impact on patients’ quality of life. Research studies have shown that transcutaneous electrical acupoint stimulation (TEAS) may reduce the cumulative dosage of intraoperative anesthetics as well as postoperative pain medications in these patients. Objective To investigate the effect of pTEAS on pain management and clinical outcome in major spinal surgery patients. Methods We conducted a prospective, randomized, double-blind study to verify the effect of pTEAS in improving pain management and clinical outcome after major spinal surgery. Patients (n = 90) who underwent posterior lumbar fusion surgery were randomized into two groups: pTEAS, (n = 45) and Control (n = 45). The pTEAS group received stimulation on acupoints Zusanli (ST.36), Sanyinjiao (SP.6), Taichong (LR.3), and Neiguan (PC.6). The Control group received the same electrode placement but with no electrical output. Postoperative pain scores, intraoperative outcome, perioperative hemodynamics, postoperative nausea and vomiting (PONV), and dizziness were recorded. Results Intraoperative outcomes of pTEAS group compared with Control: consumption of remifentanil was significantly lower (P < 0.05); heart rate was significantly lower at the end of the operation and after tracheal extubation (P < 0.05); and there was lesser blood loss (P < 0.05). Postoperative outcomes: lower pain visual analogue scale (VAS) score during the first two days after surgery (P < 0.05); and a significantly lower rate of PONV (on postoperative Day-5) and dizziness (on postoperative Day-1 and Day-5) (P < 0.05). Conclusion pTEAS could manage pain effectively and improve clinical outcomes. It could be used as a complementary technique for short-term pain management, especially in patients undergoing major surgeries. Trial registration ChiCTR1800014634, retrospectively registered on 25/01/2018. http://medresman.org/uc/projectsh/projectedit.aspx?proj=183 Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01875-3
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Jacob KC, Patel MR, Vanjani NN, Pawlowski H, Prabhu MC, Singh K. Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Isthmic Spondylolisthesis with Predominant Back Pain versus Predominant Leg Pain Symptoms. World Neurosurg 2022; 166:e672-e680. [PMID: 35933097 DOI: 10.1016/j.wneu.2022.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement following anterior or transforaminal lumbar interbody fusion for isthmic spondylolisthesis in patients presenting with predominant back pain versus predominant leg pain symptoms. METHODS A single-surgeon database was reviewed for anterior or transforaminal lumbar interbody fusion procedures for isthmic spondylolisthesis. Patient demographics, perioperative characteristics, postoperative complications, and PROMs were collected. Demographic/perioperative characteristics were compared among groups using χ2 and Student t tests for categorical and continuous variables, respectively. Mean PROM scores were compared using an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired-samples t test. MCID achievement rates were compared with χ2 analysis. RESULTS In total, 143 patients were included with 65 patients in the predominant back pain and 78 patients in the predominant leg pain cohort. Preoperative visual analog scale (VAS) leg was noted to be significantly greater in predominant leg pain cohort (P < 0.001). Cohorts demonstrated significant mean postoperative differences for the following PROMs at the following postoperative time points: significant differences were noted between cohorts for rate of achievement of MCID for the following PROMs at the following time points: VAS back at 2 years and VAS leg at 6 weeks/12 weeks/6 months/overall (P < 0.036, all). CONCLUSIONS Compared with patients presenting for surgery with predominant leg pain symptoms, patients undergoing lumbar fusion at L4-L5 and L5-S1 for isthmic spondylolisthesis with predominant back pain symptoms may demonstrate improved long-term clinical outcomes for reported back pain, leg pain, and disability and reduced postoperative length of stay and narcotic consumption.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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13
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Lange N, Stadtmüller T, Scheibel S, Reischer G, Wagner A, Meyer B, Gempt J. Analysis of risk factors for perioperative complications in spine surgery. Sci Rep 2022; 12:14350. [PMID: 35999446 PMCID: PMC9399240 DOI: 10.1038/s41598-022-18417-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Complications in spine surgery can arise in the intraoperative or the immediate postoperative period or in a delayed manner. These complications may lead to severe or even permanent morbidity if left undiagnosed and untreated. We prospectively interviewed 526 patients out of 1140 patients who consecutively underwent spinal surgery in our department between November 2017 and November 2018 and analysed the outcome and complication rates. A 12 months follow-up period was also adopted. We analysed the patients' clinical characteristics, comorbidities, surgical management, survival rates, and outcomes. Risk factor analyses for the development of complications were also performed. Patients' median age was 67 years (range: 13-96). The main diagnoses were as follows: degenerative in 50%, tumour in 22%, traumatic fractures in 13%, infections in 10%, reoperations in 3%, and others in 2%. Surgeries were emergency procedures (within 24 h) in 12%. Furthermore, 59% required instrumentation. The overall postoperative complication rate was 26%. Revision surgery was required in 12% of cases within 30 postoperative days (median time to revision 11 days [IQR 5-15 days]). The most frequent complications included wound healing disorders, re-bleeding, and CSF leakage. Thereby, the risk factor analysis revealed age-adjusted CCI (p = 0.01), metastatic tumour (p = 0.01), and atrial fibrillation (p = 0.02) as significant risk factors for postoperative complications. Additionally, postoperative KPS (p = 0.004), postoperative anaemia (p = 0.001), the length of hospital stay (p = 0.02), and duration of surgery (p = 00.002) were also identified as associated factors. Complication rates after spinal surgeries are still high, especially in patients with metastatic tumour disease and poor clinical status (KPS), requiring revision surgeries in several cases. Therefore, specific risk factors should be determined to carefully select surgery groups.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Thomas Stadtmüller
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefanie Scheibel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Gerda Reischer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
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14
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Jiang G, Zhu Y, Luo W, Zhang W, Qin W, Ou Y. What Level Should Preoperative Albumin of Thoracic and Lumbar Tuberculosis Patients Be Reached: A Case-Controlled Study. Front Nutr 2022; 9:740459. [PMID: 35571899 PMCID: PMC9097765 DOI: 10.3389/fnut.2022.740459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the risk factors of hypoalbuminemia in patients with thoracic and lumbar tuberculosis and develop a scoring scale, according to which the patients with thoracic and lumbar tuberculosis were divided into 2 groups to, respectively calculate the perioperative albumin changes and to find out the preoperative albumin recommended value. Methods A total of 166 patients with thoracic and lumbar tuberculosis, who underwent spinal focus debridement between January 2012 to May 2020, were identified into 2 groups: with and without postoperative hypoalbuminemia (n = 131 and n = 35, respectively), recording and analyzing clinical characteristics by multivariate analysis to establish a scoring scale. Using this scale, patients with spinal tuberculosis were divided into a high-risk group and a low-risk group, and then, calculated the average decrease of postoperative albumin in both groups. Combined with the diagnostic threshold of hypoalbuminemia, we proposed the preoperative albumin safe values of the patients with thoracic and lumbar tuberculosis. Results A total of 131 of 166 patients experienced postoperative hypoalbuminemia after spinal focus debridement. Multivariate binary logistic regression analysis identified pulmonary tuberculosis (adjusted odds ratio = 0.270, p = 0.012), pre-operative serum albumin value (adjusted odds ratio = 0.754, p < 0.001), and operation time (adjusted odds ratio = 1.017, p = 0.002) as independent risk factors for the occurrence of postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. According to the OR value, the risk factors are assigned to make the scoring scale, the receiver operating characteristic (ROC) curve indicates that postoperative hypoalbuminemia rises when the score is greater than or equal to 4 points. The scoring scale is tested in the derivation set (166 patients) showed: sensitivity-51.9%, specificity-91.4%, and in the validation set (102 patients) showed: sensitivity-63.6% and specificity-86.1%. The perioperative albumin decreased value is 4.71 ± 2.66 g/L in the low-risk group and 8.99 ± 3.37 g/L in the high-risk group (p < 0.001). Conclusion Complicated with pulmonary tuberculosis, low preoperative albumin value and long operation time can lead to postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. The scoring scale can effectively assist physicians to evaluate whether patients with thoracic and lumbar tuberculosis develop hypoalbuminemia after surgery. The scale is simple and reliable and has clinical guiding significance. For low-risk patients and high-risk patients, preoperative albumin values should reach 40 and 44 g/L, respectively, to effectively avoid postoperative hypoalbuminemia.
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15
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Singleton M, Ghisi D, Memtsoudis S. Perioperative management in complex spine surgery: a narrative review. Minerva Anestesiol 2022; 88:396-406. [PMID: 35315618 DOI: 10.23736/s0375-9393.22.15933-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multi-level spinal arthrodesis and osteotomies. Moreover, different surgical approaches are described at different spine levels: the anesthesiologist should be aware of the potential benefits and risks for the patients and be prepared for their management. In this narrative review we seek to describe basic concepts of perioperative spine care and address evolving areas in which care is changing. We will discuss preoperative concerns, intraoperative management including airway management, choice of maintenance, intraoperative neuromonitoring and anesthetic effect, blood management and the dynamic topic of anesthetic and analgesic techniques. Finally, we will briefly address the issue of perioperative complications as they relate specifically to spine surgery.
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Affiliation(s)
- Michael Singleton
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Daniela Ghisi
- Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, Bologna, Italy -
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.,Department of Public Health, Division of Epidemiology, Weill Cornell Medical College, New York, NY, USA
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16
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Wan T, Xiao Z, Wang X, Tan H, Guo W, Tang G, Chen L, Mei Z, Cao Q. Sarcopenia for outcomes in patients undergoing spinal surgery: A protocol for a systematic review and pooled analysis of observational studies. PLoS One 2022; 17:e0264268. [PMID: 35275924 PMCID: PMC8916656 DOI: 10.1371/journal.pone.0264268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcopenia is a progressive age-related skeletal muscle disorder characterized by decreased muscle mass and loss of muscle function. Recent studies have shown that sarcopenia is able to predict a variety of clinical outcomes after spinal surgery. Controversy still exists among previous reports in terms of the definition and measurement of sarcopenia, these findings are heterogeneous so far. Therefore, the aim of the current study is to assess the up-to-date evidence of sarcopenia for postoperative outcomes among people undergoing spinal surgery. METHODS AND ANALYSIS This protocol was carried out based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. It has been pre-registered in PROSPERO with the registration number of CRD42021260459. Three databases (including Pubmed, EMBASE, and Cochrane Library) will be searched from inception through May 10, 2021 to determine related cohort studies examining sarcopenia on multidimensional outcomes in patients undergoing spinal surgery. Major outcomes will be involved including mortality, morbidity, length of stay, postoperative complications or adverse events. DerSimonian & Laird random-effects meta-analysis will be used to calculate pooled odds ratio (OR) for binary data and pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) for continuous data. The Newcastle-Ottawa Scale (NOS) will be used to assess the risk of bias of included studies. Narrative synthesis will be carried out if a pooled analysis is not possible. ETHICS AND DISSEMINATION Ethical approval is not required for this study as the data involved are from the published literatures. We intend to disseminate or share the results of the study in a peer-reviewed journal or at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42021260459.
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Affiliation(s)
- Teng Wan
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
- Departments of Physiology and Biochemistry, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Zhihong Xiao
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Xitao Wang
- Department of Surgery, Binhai New Area Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Haifeng Tan
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
- Departments of Physiology and Biochemistry, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Weiming Guo
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Guojun Tang
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Liangyuan Chen
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Zubing Mei
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Qi Cao
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
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17
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Fan M, Fang Y, Zhang Q, Zhao J, Liu B, Tian W. A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery. BMC Surg 2022; 22:47. [PMID: 35148734 PMCID: PMC8832639 DOI: 10.1186/s12893-022-01503-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background Robot-assisted open surgery (RA-OS) is now commonly used in traditional open-exposure spinal screw placement surgery. With the help of robots, robot-assisted minimally invasive surgery (RA-MIS) can achieve less bleeding and less tissue damage in percutaneous screw insertion. While the research comparing the safety and accuracy of screw placement between RA-MIS and RA-OS is insufficient. This study aims to compare the effects of RA-MIS and RA-OS in thoracic and lumbar spine. Methods This was a prospective cohort study evaluating 208 patients undergoing robot-assisted screw insertions from July 2020 to September 2021. Age, BMI, gender, screws accuracy, screws Gertzbein–Robbins grade, small joint invasion and perioperative outcomes (operation time, blood loss, postoperative hospital stay, comorbidity) were collected. A subgroup analysis was also performed according to disease, namely fracture, spondylolisthesis, and disc herniation. Data were analyzed using Stata/MP 14.0. Wilcoxon’s signed rank test, Kruskal–Wallis test and Fisher’s exact test were used for statistical tests and p < 0.05 was considered statistically significant. Results A total of 1030 screws were inserted; 368 minimally invasive screws and 662 open screws. The acceptability of screw insertion in the RA-MIS and RA-OS was 97.3% and 95.6% respectively. There was no statistical difference between the RA-MIS group and RA-OS group in age (p = 0.106), gender (p = 0.074), BMI (p = 0.181) and comorbidity (p = 0.203). Compared with RA-OS, RA-MIS had less blood loss (p < 0.001) and shorter postoperative hospital stay (p = 0.008). In the minimally invasive surgery group, the fracture subgroup had smaller screw deviation, less blood loss, and shorter operation time compared with the other subgroups (p < 0.01). Specifically, RA-MIS significantly reduced the postoperative hospital stay of patients with spondylolisthesis compared with RA-OS (p < 0.01). Conclusion RA-OS and RA-MIS had equal accuracy and safety. Compared with open surgery, minimally invasive surgery reduced blood loss in each subgroup and shortened the postoperative hospital stay in the spondylolisthesis subgroup. Compared with the other subgroups under minimally invasive surgery, the fracture subgroup had less blood loss and shorter operation time. Clinical trial registration: NCT04040868. Registered 1 March 2019, https://clinicaltrials.gov/ct2/show/NCT04040868?cond=Accuracy+Study+of+Robot-assisted+Screw+Insertion+in+Spinal+Surgery&draw=2&rank=1.
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Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yanming Fang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qi Zhang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China. .,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China.
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18
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Value of Postoperative Serum Albumin to Predict Postoperative Complication Severity in Spinal Tuberculosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4946848. [PMID: 35187165 PMCID: PMC8850042 DOI: 10.1155/2022/4946848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/03/2022]
Abstract
Background Many complications occur after surgery in patients with spinal tuberculosis (STB); however, the severity varies in different patients. The complications' severity is evaluated from grades I to V by the Clavien–Dindo classification (CDC), and grade V is the most severe. Most complications are mild, and only severe complications are life threatening, and thus, it is important to identify severe complications in patients with STB. The purpose of this study was to identify the risk factors of postoperative complication severity in patients with STB. Methods Between January 2012 and May 2021, a retrospective study included 188 patients that underwent STB debridement surgery. The patients were divided into three groups based on postoperative complication severity. Clinical characteristics measured included age, sex, body mass index (BMI), comorbidities of diabetes mellitus and pulmonary tuberculosis, alcohol use and smoking history, course of disease, preoperative hemoglobin, preoperative serum albumin, preoperative lymphocytes, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), surgical approach, operating time, blood loss during surgery, postoperative hemoglobin, and postoperative serum albumin. The clinical characteristics of patients with STB who developed postoperative complications were evaluated using logistic regression analysis. Results 188 patients suffered at least one postoperative complication; 77, 91, and 20 patients experienced grade I, II, and III-IV complications, respectively. In the univariate analysis, sex, diabetes mellitus, postoperative hemoglobin, and postoperative albumin are statistically significant. In the multivariable analysis, postoperative albumin (adjusted odds ratio (OR) = 0.861, P < 0.001) was an independent risk factor of the postoperative complication severity in patients with STB. Receiver operating characteristic (ROC) analysis showed that the optimal cutoff values for postoperative albumin were 32 g/L (sensitivity: 0.571, specificity: 0.714, area under the ROC curve: 0.680) and 30 g/L (sensitivity: 0.649, specificity: 0.800, area under the ROC curve: 0.697) for grade II and grade III-IV complications, respectively. Conclusions Postoperative albumin is an independent risk factor for postoperative complication severity in patients with STB. The improvement of postoperative albumin levels may reduce the risk of severe complications in patients with STB.
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19
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Yang S, Liao W. Hydroxysafflor yellow A attenuates oxidative stress injury-induced apoptosis in the nucleus pulposus cell line and regulates extracellular matrix balance via CA XII. Exp Ther Med 2022; 23:182. [PMID: 35069863 PMCID: PMC8764902 DOI: 10.3892/etm.2021.11105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) is the main cause of lower back pain. Oxidative stress injury and degradation of the extracellular matrix (ECM) are important factors causing IVDD, while hydroxysafflor yellow A (HSYA) has significant anti-oxidative stress and anti-apoptotic effects. The present study aimed to investigate the protective role of HSYA in IVDD using nucleus pulposus (NP) cells. A Cell Counting Kit-8 assay was used to detect cell viability following HSYA and tert-Butyl hydroperoxide (TBHP) treatment. Cellular reactive oxygen species levels and the level of apoptosis were measured using flow cytometry. The concentration of superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase GSH-Px were detected using ELISA. DAPI staining was performed for nuclear morphology analysis, while western blot analysis was used to detect apoptotic- and ECM-related protein expression levels. Bioinformatics analysis was used to predict the binding site between HSYA and carbonic anhydrase 12 (CA12; CA XII). NP cells were transfected withsmall interference RNA (siRNA) for CA XII downregulation. Following TBHP treatment, the level of ROS increased significantly, and the concentrations of SOD, CAT and GSH-Px were decreased. In addition, the apoptosis level of the NP cell line significantly increased following TBHP treatment. Furthermore, the expression levels of ECM-related proteins, collagen II and aggrecan were significantly decreased, and the protein expression level of MMP-13 was significantly increased. HSYA (10 µM) could effectively alleviate the effects of TBHP on NP cell apoptosis, oxidative stress damage and the expression level of ECM-related proteins. A binding site was found between HSYA and CA XII. In addition, CA XII-siRNA significantly reduced the increase in the expression level of collagen II and aggrecan proteins and decrease in the expression level of MMP-13 induced by HSYA in the NP cell line. In conclusion, HSYA could attenuate oxidative stress injury and apoptosis induced by TBHP in the NP cell line, and could improve the regulation of ECM balance.
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Affiliation(s)
- Shuo Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Wenbo Liao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
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20
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Beloborodov VA, Stepanov IA. [Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs]. Khirurgiia (Mosk) 2022:15-22. [PMID: 35080822 DOI: 10.17116/hirurgia202201115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD). MATERIAL AND METHODS A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD. RESULTS Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease. CONCLUSION Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.
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Affiliation(s)
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Hospital, Irkutsk, Russia
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21
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Porche K, Maciel CB, Lucke-Wold B, Robicsek SA, Chalouhi N, Brennan M, Busl KM. Preoperative prediction of postoperative urinary retention in lumbar surgery: a comparison of regression to multilayer neural network. J Neurosurg Spine 2022; 36:32-41. [PMID: 34507288 PMCID: PMC9608355 DOI: 10.3171/2021.3.spine21189] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spine surgery and is associated with prolongation of hospital stay, increased hospital cost, increased rate of urinary tract infection, bladder overdistention, and autonomic dysregulation. POUR incidence following spine surgery ranges between 5.6% and 38%; no reliable prediction tool to identify those at higher risk is available, and that constitutes an important gap in the literature. The objective of this study was to develop and validate a preoperative risk model to predict the occurrence of POUR following routine elective spine surgery. METHODS The authors conducted a retrospective chart review of consecutive adults who underwent lumbar spine surgery between June 1, 2017, and June 1, 2019. Patient characteristics, preexisting ICD-10 codes, preoperative pain and opioid use, preoperative alpha-1 blocker use, details of surgical planning, development of POUR, and management strategies were abstracted from electronic medical records. A binomial logistic model and a multilayer perceptron (MLP) were optimized using training and validation sets. The models' performance was then evaluated on model-naïve patients (not a part of either cohort). The models were then stacked to take advantage of each model's strengths and to avoid their weaknesses. Four additional models were developed from previously published models adjusted to include only relevant factors (i.e., factors known preoperatively and applied to the lumbar spine). RESULTS Overall, 891 patients were included in the cohort, with a mean of 59.6 ± 15.5 years of age, 52.7% male, BMI 30.4 ± 6.4, American Society of Anesthesiologists class 2.8 ± 0.6, and a mean of 5.6 ± 5.7 comorbidities. The rate of POUR was found to be 25.9%. The two models were comparable, with an area under the curve (AUC) of 0.737 for the regression model and 0.735 for the neural network. By combining the two models, an AUC of 0.753 was achieved. With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, maximal sensitivity and specificity were achieved, with specificity 68.2%, sensitivity 72.9%, negative predictive value 88.2%, and positive predictive value 43.4%. Both models individually outperformed previously published models (AUC 0.516-0.645) when applied to the current data set. CONCLUSIONS This predictive model can be a powerful preoperative tool in predicting patients who will be likely to develop POUR. By using a combination of regression and neural network modeling, good sensitivity, specificity, and NPV are achieved.
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Affiliation(s)
- Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carolina B. Maciel
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Steven A. Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Nohra Chalouhi
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Meghan Brennan
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Katharina M. Busl
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
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22
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Hanney WJ, Munyon MD, Mangum LC, Rovito MJ, Kolber MJ, Wilson AT. Perceived barriers to accessing physical therapy services in Florida among individuals with low back pain. FRONTIERS IN HEALTH SERVICES 2022; 2:1032474. [PMID: 36925789 PMCID: PMC10012755 DOI: 10.3389/frhs.2022.1032474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
Background Low back pain (LBP) affects up to 84% of adults and physical therapy (PT) has been reported to be an effective approach to conservative care. For those individuals with LBP referred to PT, the decision to initiate and follow through with care is influenced by numerous factors. Currently, a paucity of evidence exists to identify barriers for patients with LBP to access PT care. Thus, the purpose of this study was to investigate perceived barriers influencing the decision to pursue PT care in the state of Florida. Methods A purposive survey was administered via Qualtrics ESOMAR. Screener questions ensured candidates had LBP, resided in Florida, and were referred to PT. Participants that met the screener questions were offered an opportunity to participate in the full survey. Once a participant completed the full survey, variables assessing LBP, access to PT services, and potential barriers were analyzed. A partial least squares structural equation model (PLS-SEM) via WarpPLS 7.0 was used to explore which of the perceived barriers had the greatest influence on whether an individual with LBP was able to pursue PT care. Results The conceptual framework that demonstrated the best fit of direct effects of potential barriers to accessing care included six independent exogenous latent variables: (a) unaware of a PT clinic near their home or work, (b) had children but no childcare for them, (c) had long PT sessions (e.g., 60 min), (d) had more than one PT session per week, (e) had fewer days active per week, and (f) exercised fewer times per day. Together the six variables explained 19% of the variance related to following through with care (R 2 = 0.19). Conclusions The ability of an individual with LBP to access PT care in the state of Florida is multifactorial. There appears to be three broad factors that are the primary barriers, which include (a) the logistic ability (location and access to childcare) to attend PT treatment, (b) how much time is dedicated to the PT treatment, and (c) activity frequency of the individual seeking care. These findings support previous conceptual frameworks for predicting PT treatment. Practitioners and policy makers should consider these barriers when developing plans for conservative management of LBP in Florida.
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Affiliation(s)
- W J Hanney
- Musculoskeletal Laboratory, Institute of Exercise Physiology and Rehabilitation Sciences, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, United States
| | - M D Munyon
- Orblytics, LLC, Orlando, FL, United States
| | - L C Mangum
- Rehabilitation, Athletic Assessment & Dynamic Imaging (READY) Lab, Institute of Exercise Physiology and Rehabilitation Sciences, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, United States
| | - M J Rovito
- Department of Health Sciences, University of Central Florida, Orlando, FL, United States
| | - M J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - A T Wilson
- Musculoskeletal Laboratory, Institute of Exercise Physiology and Rehabilitation Sciences, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, United States
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Hajjar MS, Atallah GM, Oneissi A, Beaineh P, Abu-Sittah GS. What is the role of incisional vacuum therapy in challenging spinal wounds? A single centre experience. J Wound Care 2021; 30:476-481. [PMID: 34121438 DOI: 10.12968/jowc.2021.30.6.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A surgical approach to the treatment of spinal defects and disorders has become more common because of the medical and technological advancements achieved in the last decade. This rising trend in spinal surgeries is associated with adverse events, most notably wound complications. From its introduction, negative pressure wound therapy (NPWT) has proved to be essential in the management of complex wounds and in speeding up wound recovery. The aim of this study is to investigate the use of incisional NPWT in patients undergoing spinal surgery and its role in the prevention of wound complications. METHOD This study is a retrospective medical chart review conducted on patients who underwent spinal surgery and received incisional vacuum therapy as part of their treatment. The apparatus was applied intraoperatively following the spinal surgery for all patients included in this study. All surgical procedures were conducted between September 2019 and May 2020. Data entry and analysis were performed between September and October 2020. RESULTS A total of five patients' records were reviewed. In our healthcare centre, three patients developed seroma, one developed haematoma, four required revision surgery and one patient required re-operation. There was no wound dehiscence and none of the wounds became infected. Mean length of hospital stay was 11.2 days (standard deviation (SD): 9.5 days) and mean operation time was 333 minutes (SD: 86.4 minutes). CONCLUSION There is a scarcity of data on the role of incisional vacuum therapy in the prevention of wound complications associated with spine surgeries. Our study showed promising results for the use of incisional NPWT in the management of spinal wounds. Further research is required in order to enhance wound care by exploiting this potentially beneficial approach.
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Affiliation(s)
- Marwan S Hajjar
- Department of Surgery, Division of Plastic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georgio M Atallah
- Department of Surgery, Division of Plastic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneissi
- Department of Surgery, Division of Plastic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paul Beaineh
- Department of Surgery, Division of Plastic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan S Abu-Sittah
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Lebanon
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Quercetin Alleviates Intervertebral Disc Degeneration by Modulating p38 MAPK-Mediated Autophagy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6631562. [PMID: 34055990 PMCID: PMC8133869 DOI: 10.1155/2021/6631562] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/06/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023]
Abstract
Intervertebral disc degeneration (IVDD) is a degenerative and chronic spinal disorder often associated with the older population. Oxidative stress is a major pathogenic factor of aging that results in the apoptosis of nucleus pulposus cells (NPCs) and extracellular matrix (ECM) degradation. Quercetin (QUE), a naturally occurring flavonoid with antioxidant and anti-inflammatory properties, has been studied in research on degenerative diseases. However, the potential effects and mechanisms of action of QUE on IVDD remain unclear. In this study, the effects of QUE on antiapoptosis and ECM metabolism were firstly investigated in TBHP-treated NPCs. Meanwhile, the autophagy inhibitor, 3-MA, and p38 MAPK inhibitor, SB203580, were used in subsequent TBHP-induced NPC experiments to determine whether QUE exerted its protective effects through autophagy and the p38 MAPK/mTOR signaling pathway. Finally, the therapeutic effects of QUE were confirmed in vivo using a rat tail needle puncture-induced model of IVDD. We found that QUE treatment significantly alleviated oxidative stress-decreased cell viability and intracellular ROS levels in NPCs treated with TBHP. Furthermore, treatment with QUE led to a decrease in apoptosis as measured by decreased Bax and increased Bcl-2 expression and PE/7-AAD flow cytometry analysis. QUE also promoted ECM stability as measured by increased collagen II and aggrecan and decreased MMP13 levels. Our results also showed that QUE promoted the expression of autophagy markers beclin-1, LC3-II/I, and decreased p62. Inhibition of autophagy by inhibitor 3-MA may partially reverse the protective effect of QUE on apoptosis and ECM degeneration, indicating that autophagy was involved in the protective effect of QUE in NPCs. Further study confirmed that QUE partially inhibited the p38 MAPK signaling pathway and inhibition of p38 MAPK by SB203580 activated autophagy, indicating that QUE protected NPCs against apoptosis and prevented ECM degeneration via the p38 MAPK-autophagy pathway. Finally, using a rat tail puncture-induced model of IVDD, we confirmed that QUE had a protective effect against IVDD. Our results suggest that QUE could prevent IVDD by modulating p38 MAPK-mediated autophagy and, therefore, is a potential therapeutic strategy in the treatment of IVDD.
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Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J 2021; 21:729-752. [PMID: 33444664 DOI: 10.1016/j.spinee.2021.01.001] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program. STUDY DESIGN This is a review article. METHODS Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature. RESULTS Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. CONCLUSION Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Thomas W Wainwright
- Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Freyr G Sigmundsson
- Department of Orthopedic Surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden
| | - Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Aurélien Bonnal
- Department of Anesthesiology, Clinique St-Jean- Sud de France, Santécité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery - Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, SantéCité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, the Netherlands
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Abe H, Inoue R, Tsuchida R, Azuma K, Ino K, Konishi M, Hozumi J, Sumitani M. Use of three-dimensional printing of a lumbar skeletal model for intrathecal administration of nusinersen: a brief technical report. Reg Anesth Pain Med 2020; 45:757-760. [PMID: 32817238 DOI: 10.1136/rapm-2020-101607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022]
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive hereditary neurodegenerative disease causing progressive muscle atrophy, weakness and kyphoscoliosis. Nusinersen is a therapeutic agent for SMA that should be administered intrathecally. However, due to severe kyphoscoliosis, lumbar puncture can be challenging. Here, we present our experience of intrathecal administration of nusinersen in an SMA patient with severe kyphoscoliosis using a life-size three-dimensional printing (3D) skeletal model created with 3D printer. With this strategy, we were able to rapidly and safely perform the lumbar puncture.
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Affiliation(s)
- Hiroaki Abe
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Reo Inoue
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Rikuhei Tsuchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kenji Azuma
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Kenji Ino
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Mitsuru Konishi
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Jun Hozumi
- Department of Medical Community Network and Discharge Planning, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku, Japan
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Chang SY, Mok S, Park SC, Kim H, Chang BS. Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review. Asian Spine J 2020; 14:513-525. [PMID: 32791769 PMCID: PMC7435309 DOI: 10.31616/asj.2020.0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sujung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Nascimento FCLD, Rodrigues MCS. Risk for surgical positioning injuries: scale validation in a rehabilitation hospital. Rev Lat Am Enfermagem 2020; 28:e3261. [PMID: 32401901 PMCID: PMC7217622 DOI: 10.1590/1518-8345.2912.3261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.
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[Intraoperative and late complications after spinal tumour resection and dorsoventral reconstruction]. DER ORTHOPADE 2020; 49:157-168. [PMID: 31996948 DOI: 10.1007/s00132-020-03883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal tumors are a continuously growing pathology group among the spinal diseases. The often-difficult circumstances increase vulnerability to a wide range of intervention-related complications, which can occur at different times in the course of the disease and must be included in the consideration of the indication. OBJECTIVES The aim of the work is to present the wide spectrum of complications in the surgical treatment of spinal tumors, as well as their treatment and prophylaxis through optimal therapy management. MATERIALS AND METHODS The article summarizes the current literature. RESULTS The literature describes complication rates of 10-67% after metastatic surgery of the spinal column. The most common complications are infections and internal, especially pulmonary, complications. Other relevant complications include surgical positioning/surgical access/instrumentation/mechanical failure, and anesthesiological, neurological, vascular and oncological complications. The socio-economic costs for patients with complications compared to those for patients without complications are twice as high. A special risk situation exists with radical spinal tumor resections. Negative predictors are previous operations, previous irradiation and local recurrences. CONCLUSIONS An early, interdisciplinary concept can reduce complications significantly. Due to the planning intensity, surgical expertise and comprehensive structural requirements, treatment in an interdisciplinary tumour centre is necessary.
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Acarbaş A. Value of N-Terminal Pro-Brain Natriuretic Peptide in Predicting Perioperative Complications Following Spine Surgery. World Neurosurg 2019; 133:e784-e788. [PMID: 31605859 DOI: 10.1016/j.wneu.2019.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The utility of preoperative biomarkers for assessing perioperative complications in patients undergoing spine surgery (SS) is unclear, and no study has assessed the ability of preoperative natriuretic peptides to predict adverse events following SS. This study aimed to evaluate the prognostic importance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing SS. METHODS We prospectively followed 154 consecutive adult patients ≥50 years old hospitalized for elective SS. The outcomes of interest were length of stay in hospital and perioperative medical complications during hospitalization, defined as pneumonia, deep or organ space surgical site infection, bacteremia, prolonged mechanical ventilation >48 hours, unplanned reintubation, acute renal failure, sepsis or septic shock, venous thromboembolism (deep vein thrombosis or pulmonary embolism), cardiac arrest, stroke, myocardial infarction, return to operating room, and in-hospital mortality. RESULTS In 21 (13.6%) patients, 32 episodes of medical adverse events occurred. Older patients and patients with more comorbid conditions, such as heart failure, diabetes, cerebrovascular disease, coronary artery disease, and chronic obstructive pulmonary disease, tended to have a higher rate of adverse events. Patients with adverse events had higher NT-proBNP and troponin levels on admission compared with patients without adverse events. Multivariate analysis showed that NT-proBNP >242 pg/ml (odds ratio 2.374; 95% confidence interval, 1.000-2.958; P = 0.001) and presence of diabetes (odds ratio 2.16; 95% confidence interval, 1.86-7.89; P = 0.008) were significant and independent predictors of perioperative adverse events. CONCLUSIONS This study demonstrates that preoperative NT-proBNP level in patients undergoing SS could be a valuable prognostic marker for several postoperative complications.
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Affiliation(s)
- Arsal Acarbaş
- Department of Neurosurgery, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
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Igoumenou VG, Mavrogenis AF, Angelini A, Baracco R, Benzakour A, Benzakour T, Bork M, Vazifehdan F, Nena U, Ruggieri P. Complications of spine surgery for metastasis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:37-56. [DOI: 10.1007/s00590-019-02541-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
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Matrisome Profiling During Intervertebral Disc Development And Ageing. Sci Rep 2017; 7:11629. [PMID: 28912585 PMCID: PMC5599645 DOI: 10.1038/s41598-017-11960-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 09/01/2017] [Indexed: 12/19/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is often the cause of low back pain. Degeneration occurs with age and is accompanied by extracellular matrix (ECM) depletion, culminating in nucleus pulpous (NP) extrusion and IVD destruction. The changes that occur in the disc with age have been under investigation. However, a thorough study of ECM profiling is needed, to better understand IVD development and age-associated degeneration. As so, iTRAQ LC-MS/MS analysis of foetus, young and old bovine NPs, was performed to define the NP matrisome. The enrichment of Collagen XII and XIV in foetus, Fibronectin and Prolargin in elder NPs and Collagen XI in young ones was independently validated. This study provides the first matrisome database of healthy discs during development and ageing, which is key to determine the pathways and processes that maintain disc homeostasis. The factors identified may help to explain age-associated IVD degeneration or constitute putative effectors for disc regeneration.
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Schroeder J, Salzmann SN, Hughes AP, Beckman JD, Shue J, Girardi FP. Emergent reintubation following elective cervical surgery: A case series. World J Orthop 2017; 8:465-470. [PMID: 28660138 PMCID: PMC5478489 DOI: 10.5312/wjo.v8.i6.465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/06/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To review cases of emergent reintubation after cervical surgery.
METHODS Patients who were emergently intubated in the post-operative period following cervical surgery were identified. The patients’ prospectively documented demographic parameters, medical history and clinical symptoms were ascertained. Pre-operative radiographs were examined for the extent of their pathology. The details of the operative procedure were discerned.
RESULTS Eight hundred and eighty patients received anterior- or combined anterior-posterior cervical surgery from 2008-2013. Nine patients (1.02%) required emergent reintubation. The interval between extubation to reintubation was 6.2 h [1-12]. Patients were kept intubated after reintubation for 2.3 d [2-3]. Seven patients displayed moderate postoperative edema. One patient was diagnosed with a compressive hematoma which was subsequently evacuated in the OR. Another patient was diagnosed with a pulmonary effusion and treated with diuretics. One patient received a late debridement for an infected hematoma. Six patients reported residual symptoms and three patients made a complete recovery.
CONCLUSION Respiratory compromise is a rare but potentially life threatening complication following cervical surgery. Patients at increased risk should be monitored closely for extended periods of time post-operatively. If the airway is restored adequately in a timely manner through emergent re-intubation, the outcome of the patients is generally favorable.
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A review of postsurgical dysphagia in nonmalignant disease. Curr Opin Otolaryngol Head Neck Surg 2016; 24:477-482. [DOI: 10.1097/moo.0000000000000306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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