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Passias PG, Tretiakov PS, Das A, Thomas Z, Krol O, Joujon-Roche R, Williamson T, Imbo B, Owusu-Sarpong S, Lebovic J, Diebo B, Vira S, Lafage V, Schoenfeld AJ. Outcomes and survival analysis of adult cervical deformity patients with 10-year follow-up. Spine J 2024; 24:488-495. [PMID: 37918570 DOI: 10.1016/j.spinee.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/28/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Previous studies have demonstrated that adult cervical deformity patients may be at increased risk of death in conjunction with increased frailty or a weakened physiologic state. However, such studies have often been limited by follow-up duration, and longer-term studies are needed to better assess temporal changes in ACD patients and associated mortality risk. PURPOSE To assess if patients with decreased comorbidities and physiologic burden will be at lessened risk of death for a greater length of time after undergoing adult cervical deformity surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Two hundred ninety ACD patients. OUTCOME MEASURES Morbidity and mortality data. METHODS Operative ACD patients ≥18 years with pre-(BL) and 10-year (10Y) data were included. Patients were stratified as expired versus living, as well as temporally grouped by Expiration prior to 5Y or between 5Y and 10Y. Group differences were assessed via means comparison analysis. Backstep logistic regression identified mortality predictors. Kaplan-Meier analysis assessed survivorship of expired patients. Log rank analysis determined differences in survival distribution groups. RESULTS Sixty-six total patients were included (60.97±10.19 years, 48% female, 28.03±7.28 kg/m2). Within 10Y, 12 (18.2% of ACD cohort) expired. At baseline, patients were comparable in age, gender, BMI, and CCI total on average (all p>.05). Furthermore, patients were comparable in BL HRQLs (all p>.05). However, patients who expired between 5Y and 10Y demonstrated higher BL EQ5D and mJOA scores than their earlier expired counterparts at 2Y (p<.021). Furthermore, patients who presented with no CCI markers at BL were significantly more likely to survive until the 5Y-10Y follow-up window. Surgically, the only differences observed between patients who survived until 5Y was in undergoing osteotomy, with longer survival seen in those who did not require it (p=.003). Logistic regression revealed independent predictors of death prior to 5Y to be increased BMI, increased frailty, and increased levels fused (model p<.001). KM analysis found that by Passias et al frailty, not frail patients had mean survival time of 170.56 weeks, versus 158.00 in frail patients (p=.949). CONCLUSIONS Our study demonstrates that long-term survival after cervical deformity surgery may be predicted by baseline surgical factors. By optimizing BMI, frailty status, and minimizing fusion length when appropriate, surgeons may be able to further assist ACD patients in increasing their survivability postoperatively.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA.
| | - Peter S Tretiakov
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Ankita Das
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Zach Thomas
- New York Medical College, Westchester Medical Center, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Oscar Krol
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Rachel Joujon-Roche
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Tyler Williamson
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Bailey Imbo
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Stephane Owusu-Sarpong
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Jordan Lebovic
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, 301 East 17th St, New York, NY 10003, USA
| | - Bassel Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School at Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Virginie Lafage
- Lenox Hill Hospital, Northwell Health, Department of Orthopaedics, 130 E 77th St 7th Floor, New York, NY 10075, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, 75 Francis Street, Boston, MA 02115, USA
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Liu Y, Yang X, He Z, Li J, Li Y, Wu Y, Manyande A, Feng M, Xiang H. Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis. Front Neurol 2023; 14:1304153. [PMID: 38116113 PMCID: PMC10729761 DOI: 10.3389/fneur.2023.1304153] [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: 10/08/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
Background Spinal cord injuries, often resulting from spine fractures, can lead to severe lifelong symptoms such as paraplegia and even mortality. Over the past few decades, there has been a concerning increase in the annual incidence and mortality rates of spinal cord injuries, which has also placed a growing financial strain on healthcare systems. This review aims to offer a comprehensive overview of spinal cord injuries by estimating their global incidence, prevalence, and the impact in terms of years lived with disability, using data obtained from the 2019 Global Burden of Disease Study. Method In this study, we utilized data from the 2019 Global Burden of Disease Study, a widely recognized source for global health data. Our methodology involved estimating the global incidence and prevalence of spinal cord injuries while also assessing the impact on years lived with a disability. We analyzed this data comprehensively to identify patterns and trends and made predictions. Finding This research delved into the evolving trends in the global burden of spinal cord injuries, identified key risk factors, and examined variations in incidence and disability across different Socio-demographic Index (SDI) levels and age groups. Briefly, in 2019, the global incidence and burden of YLDs of SCI significantly increased compared to 1990. While males had higher incidence rates compared to females. Falls were identified as the primary cause of SCI. Trend projections up to 2030 revealed a slight decrease in ASIR for males, an upward trend in age-specific incidence rates for both sexes and a similar pattern in age-standardized YLD rates. Additionally, our findings provided crucial groundwork for shaping future policies and healthcare initiatives, with the goal of mitigating the burden of spinal cord injuries, enhancing patient outcomes, and fortifying prevention efforts. Interpretation Understanding the global burden of spinal cord injuries is essential for designing effective healthcare policies and prevention strategies. With the alarming increase in prevalence rates and their significant impact on individuals and healthcare systems, this research contributes vital insights to guide future efforts in reducing the incidence of spinal cord injuries, improving the quality of life for affected individuals, and reducing the economic burden on healthcare systems worldwide.
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Affiliation(s)
- Yanbo Liu
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuesong Yang
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhigang He
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Li
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yijing Li
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanqiong Wu
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, United Kingdom
| | - Maohui Feng
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Clinical Medical Research Center of Peritoneal Cancer of Wuhan, Clinical Cancer Study Center of Hubei Provence, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Hongbing Xiang
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Troughton JG, Ansong Snr YO, Duobaite N, Proctor CM. Finite element analysis of electric field distribution during direct current stimulation of the spinal cord: Implications for device design. APL Bioeng 2023; 7:046109. [PMID: 37928641 PMCID: PMC10624505 DOI: 10.1063/5.0163264] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/15/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Spinal cord injury (SCI) arises from damage to the spinal cord, often caused by trauma or disease. The resulting sensorimotor dysfunction is variable and dependent on the extent of the injury. Despite years of research, curative options for SCI remain limited. However, recent advancements in electric field stimulated axonal regrowth have shown promise for neuronal regeneration. One roadblock in the development of therapeutic treatments based on this is a lack of understanding of the exogenous electric field distribution in the injured tissue, and in particular, how this is influenced by electrode geometry and placement. To better understand this electric field, and provide a means by which it can be optimized, we have developed a finite element model of such spinal cord treatment. We investigate the impact of variations in electrode geometry, spinal cord size, and applied current magnitude as well as looking at several injury models in relation to clinically observed outcomes. Through this, we show that electrode shape has little effect on the induced electric field, that the placement of these electrodes has a noticeable influence on the field distribution, and that the magnitude of this field is governed by both the applied current and the spinal cord morphology. We also show that the injury modality influences the induced field distribution and that a stronger understanding of the injury will help decide treatment parameters. This work provides guidance in the design of electrodes for future clinical application in direct current electric field stimulation for axonal regeneration.
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Affiliation(s)
| | - Yaw O. Ansong Snr
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, United Kingdom
| | - Nida Duobaite
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, United Kingdom
| | - Christopher M. Proctor
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Huang J, Yan K, Wu C, Tan QC, Bai H, Wang J, Liao B, Wu ZX. Prognosis and conditional nomogram of cervical spine fracture in patients with severe spinal cord injury: a multicenter retrospective study. Int J Surg 2023; 109:1271-1280. [PMID: 36999783 PMCID: PMC10389578 DOI: 10.1097/js9.0000000000000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Cervical spine fractures with severe spinal cord injury (SCI) are common following cervical spine trauma and are associated with a high mortality rate. Understanding the mortality patterns of patients with cervical spine fractures and severe SCI can offer valuable evidence to surgeons and family members who are required to make critical healthcare decisions. The authors aimed to evaluate the instantaneous death risk and conditional survival (CS) of such patients and developed conditional nomograms to account for different periods of survivors and predict the survival rates. METHODS Their instantaneous death risks were calculated using the hazard function, and the Kaplan-Meier method was used to evaluate the survival rates. Cox regression was used to choose the variables for the construction of the nomograms. The area under the receiver operating characteristic curve and calibration plots were used to validate the performance of the nomograms. RESULTS The authors finally included 450 patients with cervical spine fractures and severe SCI using propensity score matching. The instantaneous death risk was the highest during the first 12 months after injury. Surgical treatment can help decrease the instantaneous death risk quickly, especially in early-term surgery. The 5-year CS increased constantly from 73.3% at baseline to 88.0% after 2 years of survival. Conditional nomograms were constructed at baseline and in those who survived for 6 and 12 months. The area under the receiver operating characteristic curve and calibration curves indicated that the nomograms had a good performance. CONCLUSION Their results improve our understanding of the instantaneous death risk of patients in different periods following injury. CS demonstrated the exact survival rate among medium-term and long-term survivors. Conditional nomograms are suitable for different survival periods in predicting the probability of survival. Conditional nomograms help in understanding the prognosis and improve the shared decision-making approaches.
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Affiliation(s)
| | - Kang Yan
- Department of Orthopaedics, Tangdu Hospital, The Air Force Medical University, Xi’an, Shaanxi
| | - Chenyu Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | | | - Hao Bai
- Department of Orthopaedics, Xijing Hospital
| | - Jing Wang
- Department of Orthopaedics, Xijing Hospital
| | - Bo Liao
- Department of Orthopaedics, Tangdu Hospital, The Air Force Medical University, Xi’an, Shaanxi
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Li X, Yan B, Du J, Xu S, Liu L, Pan C, Kang X, Zhu S. Recent Advances in Progresses and Prospects of IL-37 in Central Nervous System Diseases. Brain Sci 2022; 12:brainsci12060723. [PMID: 35741608 PMCID: PMC9221119 DOI: 10.3390/brainsci12060723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022] Open
Abstract
Interleukin-37 (IL-37) is an effective anti-inflammatory factor and acts through intracellular and extracellular pathways, inhibiting the effects of other inflammatory cytokines, such as IL-1β, IL-6, and tumor necrosis factor-α (TNF-α), thereby exerting powerful anti-inflammatory effects. In numerous recent studies, the anti-inflammatory effects of IL-37 have been described in many autoimmune diseases, colitis, and tumors. However, the current research on IL-37 in the field of the central nervous system (CNS) is not only less, but mainly for clinical research and little discussion of the mechanism. In this review, the role of IL-37 and its associated inflammatory factors in common CNS diseases are summarized, and their therapeutic potential in CNS diseases identified.
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Affiliation(s)
- Xinrui Li
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
| | - Bing Yan
- Department of Anesthesiology, Haining People’s Hospital, Haining 314499, China;
| | - Jin Du
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
- China Coast Guard Hospital of the People‘s Armed Police Force, Jiaxing 314000, China
| | - Shanshan Xu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
| | - Lu Liu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
| | - Caifei Pan
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
| | - Xianhui Kang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
- Correspondence: (X.K.); (S.Z.)
| | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (X.L.); (J.D.); (S.X.); (L.L.); (C.P.)
- Correspondence: (X.K.); (S.Z.)
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