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Yagi M, Mizukoshi R, Fujita N, Funao H, Ebata S. Satisfaction following correction of spinal deformity: Cultural and regional effects on outcome. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100319. [PMID: 38559577 PMCID: PMC10973180 DOI: 10.1016/j.xnsj.2024.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Corrective spine surgery for spinal deformities, such as adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD), aims to enhance the quality of life by addressing physical impairments. However, the extent of patient satisfaction after surgery, which includes pain management, functional recovery, and psychological contentment, exhibits considerable variation across different cultural and geographical landscapes. This review describes the influence of cultural and regional disparities on postoperative satisfaction in AIS and ASD surgery with a particular emphasis on the disparities between the US and Japan. This review underscores the intricate relationship between surgical outcomes and patient-reported satisfaction metrics. The investigation reveals significant contrasts in patient satisfaction and clinical results between these 2 countries, attributed to divergent cultural expectations, lifestyle adaptations, and perceptions of bodily image. These distinctions are crucial for healthcare professionals to recognize, as they necessitate a culturally nuanced approach to patient care. This comparative review not only enhances the understanding of patient experiences across cultures but also provides valuable guidance for physicians in customizing their strategies to align with the varied expectations of their patients, thereby improving postoperative satisfaction and overall quality of life. This review emphasizes the necessity of a tailored and culturally sensitive approach to managing spinal deformities, underscoring the need to factor in cultural and regional elements to enhance patient satisfaction and surgical outcomes.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 286-8520, 852 Hatakeda Narita, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, 286-8520, 852 Hatakeda Narita, Chiba, Japan
| | - Ryo Mizukoshi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 286-8520, 852 Hatakeda Narita, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, 286-8520, 852 Hatakeda Narita, Chiba, Japan
| | - Naruhito Fujita
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 286-8520, 852 Hatakeda Narita, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, 286-8520, 852 Hatakeda Narita, Chiba, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 286-8520, 852 Hatakeda Narita, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, 286-8520, 852 Hatakeda Narita, Chiba, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 286-8520, 852 Hatakeda Narita, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, 286-8520, 852 Hatakeda Narita, Chiba, Japan
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Moore HG, Patibandla SD, McClung AM, Grauer JN, Sucato DJ, Wise CA, Johnson ME, Rathjen KE, McIntosh AL, Ramo BA, Brooks JT. Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions? J Pediatr Orthop 2023; 43:615-619. [PMID: 37694695 DOI: 10.1097/bpo.0000000000002504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS). METHODS A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using the International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ 2 tests and continuous variables were compared using independent t tests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set at P -value <0.05. RESULTS A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) ( P <0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively ( P =0.223). CONCLUSION Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Miyagi M, Saito W, Mimura Y, Nakazawa T, Imura T, Shirasawa E, Uchida K, Ikeda S, Kuroda A, Inoue S, Yokozeki Y, Tanaka Y, Akazawa T, Takaso M, Inoue G. Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1090. [PMID: 37374294 DOI: 10.3390/medicina59061090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.
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Affiliation(s)
- Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yusuke Mimura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Shinsuke Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Sho Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yuji Yokozeki
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Yoshihide Tanaka
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Tokyo 252-0374, Japan
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Yu SH, Ng CM, Cheung JPY, Shea GKH. Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°. J Bone Joint Surg Am 2023; 105:277-285. [PMID: 36689574 DOI: 10.2106/jbjs.22.00939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) curves of 50° to 75° are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40° to 50° following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group. METHODS This was a retrospective study of 73 skeletally mature patients with AIS. Following yearly or more frequent follow-up, patients were stratified as having no progression (<5° increase) or progression (≥5° increase). Those with progression were further differentiated as having standard progression (<2° increase/year) or fast progression (≥2° increase/year). Radiographic parameters (coronal balance, sagittal balance, truncal shift, apical translation, T1 tilt, apical vertebral wedging) and height were determined on skeletal maturity. Parameters that were significantly associated with progression were subject to receiver operating characteristic (ROC) curve analysis. RESULTS The average period of post-maturity follow-up was 11.8 years. The prevalence of progression was 61.6%. Among those with progression, the curve increased by a mean of 1.47° ± 1.22° per year, and among those with fast progression, by 3.0° ± 1.2° per year. Thoracic apical vertebral wedging (concave/convex vertebral height × 100) was more apparent in those with progression than in those without progression (84.1 ± 7.5 versus 88.6 ± 3.1; p = 0.003). Increased coronal imbalance (C7 plumb line to central sacral vertebral line) differentiated those with fast progression from others (16.0 ± 11.0 versus 8.7 ± 7.7 mm; p = 0.007). An ROC curve of height-corrected coronal balance demonstrated an area under the curve (AUC) of 0.722, sensitivity of 75.0%, and specificity of 72.5% in identifying fast progression. An ROC curve of height-corrected coronal balance together with apical vertebral wedging to identify those with progression demonstrated an AUC of 0.746, with specificity of 93.7% and sensitivity of 64.5%. CONCLUSIONS While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. Upon validation in larger cohorts, apical wedging and coronal imbalance may identity patients suited for closer monitoring and early spinal fusion. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sze-Hon Yu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Abu-Bonsrah N, Dada OE, Haizel-Cobbina J, Ukachukwu A, Spann M, Adu KO, Banson M, Bandoh D, Sarpong K, Dadey D, Ametefe M, Kanmounye US, Totimeh T, Groves ML. Understanding the Ghanaian Neurosurgical Literature: A Scoping Review and Bibliometric Analysis. World Neurosurg 2023; 169:12-19. [PMID: 36265747 DOI: 10.1016/j.wneu.2022.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research serves to bolster clinical neurosurgery by critically assessing various disease pathologies, while identifying important challenges and opportunities. However, there is limited information on the landscape of the Ghanaian neurosurgical literature. METHODS A scoping review and bibliometric analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched from inception until December 21, 2021 for English language articles about neurosurgery in Ghana. RESULTS 927 articles were identified and 66 were ultimately included in the analysis. A majority of them, 42.4%, were retrospective cohort studies, with 62.1% published after 2010. There were no randomized controlled or basic science studies. Most articles were published in the West African Journal of Medicine (24.2%) and non-infectious/non-traumatic spinal pathology was the most commonly discussed topic (22.7%); 66.7% of articles included only authors affiliated with Ghanaian institutions, and international collaborators frequently originated from the United States (15.9%). Only 22.7% of the manuscripts reported a funding source. Commonly reported challenges included limited sample sizes, delays in diagnosis and treatment, and lack of proper diagnostic tools and specialized care. CONCLUSIONS This review revealed that while the Ghanaian academic neurosurgery output has been increasing over time, these have been limited to cohort studies largely assessing spine pathology. The Ghanaian neurosurgical research environment may be bolstered by an increase in research funding, the establishment of longitudinal clinical databases, training in research methodology, increased incentives for researchers, strengthening of research collaborative networks, and increased engagement of neurosurgical trainees in research.
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Affiliation(s)
- Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | | | - Joseline Haizel-Cobbina
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alvan Ukachukwu
- Duke Global Neurosurgery and Neurology, Duke Hospital Department of Neurosurgery, Durham, North Carolina, USA
| | - Marcus Spann
- Informationist Services, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kojo Okyere Adu
- Department of Internal Medicine, LEKMA Hospital, Accra, Ghana
| | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Dickson Bandoh
- Department of Neurosurgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwadwo Sarpong
- Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David Dadey
- Department of Neurosurgery, Stanford University School of Medicine, San Francisco, California, USA
| | - Mawuli Ametefe
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Teddy Totimeh
- Department of Neurosurgery, University of Ghana Medical Center, Accra, Ghana
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Yagi M, Ames CP, Hosogane N, Smith JS, Shaffrey CI, Schwab FJ, Lafage V, Bess S, Matsumoto M, Watanabe K. Comparable satisfaction and clinical outcomes after surgery for adolescent idiopathic scoliosis in the adult (AISA) between the US and Japan. J Orthop Sci 2023; 28:92-97. [PMID: 34625329 DOI: 10.1016/j.jos.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The impact of ethnicity on the surgery outcomes of adolescent idiopathic scoliosis in the adult (AISA) is poorly understood. This study aimed to compare the surgery outcomes for AISA between the United States (US) and Japan (JP). METHODS 171 surgically treated AISA (20-40y) were consecutively collected from 2 separate multicenter databases. Patients were propensity-score matched for age, gender, curve type, levels fused, and 2y postop spinal alignment. Demographic and radiographic parameters were compared between the US and JP at baseline and 2y post-op. RESULTS A total of 108 patients were matched by propensity score (age; US vs. JP: 29 ± 6 vs. 29 ± 7y, females: 76 vs. 76%, curve type [Schwab-SRS TypeT; TypeD; TypeL; TypeN]: 35; 35; 30; 0 vs. 37; 33; 30; 0%)] levels fused: 10 ± 4 vs. 10 ± 4, 2y thoracic curve:17 ± 13 vs. 17 ± 12°, 2y CSVL: 10 ± 8 vs. 11 ± 9 mm). Similar clinical improvement was achieved between US and JP (function; 4.2 ± 0.9 vs 4.3 ± 0.6, p = 0.60, pain; 3.8 ± 0.9 vs 4.1 ± 0.8, p = 0.13, satisfaction; 4.3 ± 0.9 vs 4.2 ± 0.7, p = 0.61, total; 4.0 ± 0.8 vs 4.1 ± 0.5, p = 0.60). The correlation analyzes indicated that postoperative SRS-22 subdomains correlated differently with satisfaction (all subdomains moderately correlated with satisfaction in the US while only pain and mental health correlated moderately with satisfaction in JP ([function: r = 0.61 vs 0.29, pain: r = . 72 vs 0.54, self-image: r = 0.72 vs 0.37, mental health: r = 0.64 vs 0.55]). CONCLUSIONS Surgery for AISA was similarly effective in the US and JP. Satisfaction for spinal surgery among patients in different countries may not be different unless the procedure limits an individual's unique lifestyle that the patient expected to resume.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | | | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
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Computerized-Assisted Scoliosis Diagnosis Based on Faster R-CNN and ResNet for the Classification of Spine X-Ray Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3796202. [PMID: 35707041 PMCID: PMC9192275 DOI: 10.1155/2022/3796202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
In order to reduce the subjectivity of preoperative diagnosis and achieve accurate and rapid classification of idiopathic scoliosis and thereby improving the standardization and automation of spinal surgery diagnosis, we implement the Faster R-CNN and ResNet to classify patient spine images. In this paper, the images are based on spine X-ray imaging obtained by our radiology department. We compared the results with the orthopedic surgeon's measurement results for verification and analysis and finally presented the grading results for performance evaluation. The final experimental results can meet the clinical needs, and a fast and robust deep learning-based scoliosis diagnosis algorithm for scoliosis can be achieved without manual intervention using the X-ray scans. This can give rise to a computerized-assisted scoliosis diagnosis based on X-ray imaging, which has strong potential in clinical utility applied to the field of orthopedics.
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