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LaBuzetta JN, Bongbong DN, Mlodzinski E, Sheth R, Trando A, Ibrahim N, Yip B, Malhotra A, Dinglas VD, Needham DM, Kamdar BB. Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status. Neurocrit Care 2024:10.1007/s12028-024-01965-9. [PMID: 38622487 DOI: 10.1007/s12028-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5 years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
| | - Dale N Bongbong
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Eric Mlodzinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Richa Sheth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Aaron Trando
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Nicholas Ibrahim
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Brandon Yip
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
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Kerschbaum M, Klute L, Henssler L, Rupp M, Alt V, Lang S. Risk factors for in-hospital mortality in geriatric patients aged 80 and older with axis fractures: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 10,077 cases. 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 2024; 33:185-197. [PMID: 37714928 DOI: 10.1007/s00586-023-07919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To investigate the association between treatment, comorbidities, concomitant injuries, and procedures with in-hospital mortality in patients aged 80 years or older with axis fractures. METHODS Data were extracted from the German InEK (Institut für das Entgeltsystem im Krankenhaus) GmbH database (2019-2021) for patients aged 80 years or older with axis fractures and the in-hospital mortality rate was calculated. Differences in comorbidities and concomitant diseases and injuries were analyzed using the Chi-square test. In surgically treated patients, odds ratios (OR) with 95% confidence intervals (95% CI) were used to analyze potential risk factors for in-hospital mortality. RESULTS Among 10,077 patients, the in-hospital mortality rate was 8.4%, with no significant difference between surgically (9.4%) and non-surgically treated patients (7.9%; p = 0.103). The most common comorbidities were essential hypertension (67.3%), atrial fibrillation (28.2%), and chronic kidney disease (23.3%), while the most common concomitant injuries were head and face wounds (25.9%), concussions (12.8%), and atlas fractures (11.6%). In surgically treated patients, spinal cord injury (OR = 4.62, 95% CI: 2.23-9.58), acute renal failure (OR = 3.20, 95% CI: 2.26-4.53), and acute bleeding anemia (OR = 2.06, 95% CI: 1.64-2.59) were associated with increased in-hospital mortality (all p < 0.01). Screw-rod-system fixation of one segment (OR = 0.74, 95% CI: 0.56-0.97) and intraoperative navigation (OR = 0.45, 95% CI: 0.16-0.71) were identified as potential protective factors (both p < 0.05). CONCLUSION Comprehensive geriatric assessment and optimization of comorbidities during treatment are crucial. The indication for surgical treatment must be carefully individualized. Future studies should focus on the choice of surgical technique, perioperative blood management, and intraoperative navigation as potential protective factors.
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Affiliation(s)
- Maximilian Kerschbaum
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lisa Klute
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Huybregts JGJ, Barot KA, Recio C, Doucette J, Mekary RA, Vleggeert-Lankamp CLA. The optimal treatment of type II and III odontoid fractures in the elderly: an updated meta-analysis. 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; 32:3434-3449. [PMID: 37439865 DOI: 10.1007/s00586-023-07779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Odontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the outcome of surgical and conservative treatments in elderly (≥ 65 years), by updating a systematic review published by the authors in 2013. METHODS A comprehensive search was conducted in seven databases. Clinical outcome was the primary outcome. Fracture union- and stability were secondary outcomes. Pooled point estimates and their respective 95% confidence intervals (CIs) were derived using the random-effects model. A random-effects multivariable meta-regression model was used to correct for baseline co-variates when sufficiently reported. RESULTS Forty-one studies met the inclusion criteria, of which forty were case series and one a cohort study. No clinical differences in outcomes including the Neck Disability Index (NDI, 700 patients), Visual Analogue Scale pain (VAS, 180 patients), and Smiley-Webster Scale (SWS, 231 patients) scores were identified between surgical and conservative treatments. However, fracture union was higher in surgically treated patients (pooled incidence 72.7%, 95% CI 66.1%, 78.5%, 31 studies, 988 patients) than in conservatively treated patients (40.2%, 95% CI 32.0%, 49.0%, 22 studies, 912 patients). This difference remained after correcting for age and fracture type. Fracture stability (41 studies, 1917 patients), although numerically favoring surgery, did not appear to differ between treatment groups. CONCLUSION While surgically treated patients showed higher union rates than conservatively treated patients, no clinically relevant differences were observed in NDI, VAS pain, and SWS scores and stability rates. These results need to be further confirmed in well-designed comparative studies with proper adjustment for confounding, such as age, fracture characteristics, and osteoporosis degree.
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Affiliation(s)
- Jeroen G J Huybregts
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland, The Hague, The Netherlands.
| | | | - Camila Recio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rania A Mekary
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- School of Pharmacy, MCPHS University, Boston, MA, USA
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurosurgery, Spaarne Hospital Haarlem/Hoofddorp, Hoofddorp, The Netherlands
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Lodin J, Terč J, Cihlář F, Sameš M, Cihlář J, Vachata P. Dynamics of atlantoaxial rotation related to age and sex: a cross-sectional study of 308 subjects. Spine J 2023; 23:1276-1286. [PMID: 37182705 DOI: 10.1016/j.spinee.2023.05.008] [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: 03/19/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT Physiological ranges and dynamic changes of atlantoaxial rotation (ROTC1/2), total cervical spine rotation (ROTCs) and the percentage of ROTC1/2 from ROTCs (ROTCperc) for different age groups have not yet been investigated in a sufficiently sized cohort. Furthermore, it is not clear whether demographic variables such a sex, smoking status or diabetes affect ROTC1/2, ROTCs and ROTCperc. PURPOSE Obtain physiological ranges of ROTC1/2, ROTCs and ROTCperc for different age groups and determine their age-based dynamics. Investigate whether ROTC1/2, ROTCs and ROTCperc are affected by sex, smoking status or diabetes. DESIGN Observational cross-sectional study. PATIENT SAMPLE Patients undergoing elective CT examinations of the head and neck region between August 2020 and January 2022. OUTCOME MEASURES Ranges of motion of ROTC1/2, ROTCs and ROTCperc in degrees. METHODS A total of 308 subjects underwent dynamic rotational CT examinations of the upper cervical spine. Patients were divided into three age categories A1 (27-49 years), A2 (50-69 years) and A3 (≥70 years). Category A3 was further divided into B1 (70-79 years) and B2 (≥80 years). Values of ROTC1/2, ROTCs and ROTCperc were compared between all age groups, males and females, smokers and nonsmokers, diabetics a nondiabetics. Dynamics of ROTC1/2, ROTCs related to age and sex were visualized using scatterplot and trendline models. RESULTS ROTC1/2 significantly decreased from group A1 (64.4°) to B2 (46.7°) as did ROTCs from A1 (131.2°) to B2 (97.6°). No significant differences of ROTperc were found between groups A1-B2 with values oscillating between 49% and 51%. Smoking and diabetes did not significantly affect ROTC1/2, ROTCs and ROTCperc, females had significantly higher ROTCs than males. Males and females demonstrated a different dynamic of ROTC1/2 and ROTCs demonstrated by out scatterplot and trendline models. CONCLUSIONS Both ROTC1/2 and ROTCs significantly decrease with age, whereas ROTCperc remains stable. Females demonstrated higher ROTCs and their decrease of ROTC1/2 and ROTCs occurred in higher age groups compared to males. The functional repercussions atlantoaxial fusion are variable based on patient age and sex and should be taken into account prior to surgery.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic.
| | - Jan Terč
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Filip Cihlář
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Jiří Cihlář
- J. E. Purkyně University, Pasteurova 3544/1, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic
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Ishak B, Abdul-Jabbar A, von Glinski A, Yilmaz E, Unterberg AW, Hopkins S, Roh J, Oskouian R, Hart R, Chapman JR. Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians. Global Spine J 2023; 13:164-171. [PMID: 33715487 PMCID: PMC9837525 DOI: 10.1177/2192568221994793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach. METHODS We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Patient demographics, Nurick score, surgical characteristics, complications, hospital course, early outcome and 90-day mortality were collected. Comorbidities were classified using the age-adjusted Charlson Comorbidity Index (AACCI). Radiographic measurements for deformity correction included the C2-C7 sagittal Cobb angle, C2-7 sagittal vertical axis and T1 slope pre- and postoperatively. RESULTS Out of 8,521 surgically treated patients, 12 octogenarian patients had a combined anterior and posterior approach (AP group) and 14 were treated from posterior-only (P group). Mean age was 81.4 ± 1.2 and 82.5 ± 2.7 years, respectively. There was no significant difference in Nurick scores between the groups (P > 0.05). The major complication risk in the AP group was significantly higher, requiring PEG tube placement due to severe dysphagia in 4 patients (33%) compared to none in the P group. A greater improvement in cervical lordosis could be achieved through a combined approach. The 90-day mortality risk was 8% for the AP group and 0% for the P group. CONCLUSIONS A combined anterior and posterior approach is associated with a significantly higher major complication rate and can result in severe dysphagia requiring PEG tube placement in one-third of patients over 80 years of age.
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Affiliation(s)
- Basem Ishak
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Neurosurgery, Heidelberg
University Hospital, Heidelberg, Germany,Basem Ishak, University of Heidelberg,
Department of Neurosurgery, Im Neuenheimer Feld 400, 69120 Heidelberg. Germany.
| | | | - Alexander von Glinski
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Trauma Surgery, BG
University Hospital Bochum, Bochum, Germany
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Trauma Surgery, BG
University Hospital Bochum, Bochum, Germany
| | | | | | - Jeffrey Roh
- Swedish Neuroscience Institute, Seattle,
WA, USA
| | - Rod Oskouian
- Swedish Neuroscience Institute, Seattle,
WA, USA
| | - Robert Hart
- Swedish Neuroscience Institute, Seattle,
WA, USA
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Heiler U, Schray D, Pitzen T. [Early intraoperative and postoperative complications of C1-C2 fixation using the Goel-Harms technique : How often? Which? Why?]. Unfallchirurg 2021; 125:792-800. [PMID: 34713344 DOI: 10.1007/s00113-021-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Fractures of the axis are among the most frequent spinal injuries. Posterior C1-C2 fixation according to Goel-Harms is an accepted alternative to the more traditional procedures: initial stability has been shown and there is a wide range of indications but there is a paucity of data on possible complications. Such knowledge, however, is essential in order to improve outcomes.Thus, the aim of the study was:1. to describe the frequency, type and severity of early postoperative complications following C1-C2 fixation according to Goel-Harms,2. to investigate whether there is a correlation between frequency and severity of complications,3. to detect risk factors for complications.Patients included in this study were treated surgically using the C1-C2 fixation according to Goel-Harms between March 2011 and July 2018. Data were taken from our hospital database and checked via OPS 10 code "S12.1". We analyzed age, sex, ASA score, blood loss, operating time and complications. These data were extracted from clinical data sheets.A total of 134 patients were detected, 54% female, mean age 75 years and mean ASA score 3. There were 122 complications. All these complications were observed in 50% of the patients. These were mainly minor complications (32%), and 18% severe complications. Mortality was 2%. We found that patients with more severe complications also had significantly more complications when compared to patients with minor complications (Fisher's exact test, p = 0.001). Preoperative ASA score was the only risk factor to significantly influence the number (p = 0.001) and severity (p = 0.002) of postoperative complications. Each increase of the preoperative ASA score increased the risk to get one more complication by a factor of 2.55 (odds ratio 2.55) and increased the risk to get a severe complication by a factor of 2.43 (odds ratio 2.43). Intraoperative blood loss, patient age and duration of surgery, however, were not identified as risk factors for complications.
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Affiliation(s)
- Ute Heiler
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland.
| | - D Schray
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland
| | - T Pitzen
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland
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Ishak B, Frieler S, Rustagi T, von Glinski A, Blecher R, Norvell DC, Unterberg A, Strot S, Roh J, Hart RA, Oskouian R, Chapman JR. Rates of early complications and mortality in patients older than 80 years of age after surgical treatment of acute traumatic spinal fractures: ankylosing spondylitis versus osteoporosis. Neurosurg Focus 2021; 51:E4. [PMID: 34598129 DOI: 10.3171/2021.7.focus21150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to analyze the early complications and mortality associated with multilevel spine surgery for unstable fractures in patients older than 80 years of age with ankylosing spondylitis and to compare the results with an age- and sex-matched cohort of patients with unstable osteoporotic fractures. METHODS A retrospective review of the electronic medical records at a single institution was conducted between January 2014 and December 2019. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were stratified using the age-adjusted Charlson Comorbidity Index (CCI). RESULTS Among 11,361 surgically treated patients, 22 patients with ankylosing spondylitis (AS group) and 24 patients with osteoporosis (OS group) were identified. The mean ages were 83.1 ± 3.1 years and 83.2 ± 2.6 years, respectively. A significant difference in the mean CCI score was found (7.6 vs 5.6; p < 0.001). Multilevel posterior fusion procedures were conducted in all patients, with 6.7 ± 1.4 fused levels in the AS group and 7.1 ± 1.1 levels fused in the OS group (p > 0.05). Major complications developed in 10 patients (45%) in the AS group compared with 4 patients (17%) in the OS group (p < 0.05). The 90-day mortality was 36% in the AS group compared with 0% in the OS group (p < 0.001). CONCLUSIONS Patients older than 80 years of age with AS bear a high risk of adverse events after multilevel spinal fusion procedures. The high morbidity and 90-day mortality should be clearly discussed and carefully weighed against surgical treatment.
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Affiliation(s)
- Basem Ishak
- 1Swedish Neuroscience Institute, Seattle; and.,2Department of Neurosurgery, Heidelberg University Hospital, Heidelberg; and
| | - Sven Frieler
- 1Swedish Neuroscience Institute, Seattle; and.,4Department of Trauma Surgery, BG University Hospital Bochum, Germany
| | - Tarush Rustagi
- 3Indian Spinal Injuries Centre, Vasant Kunj New Delhi, Delhi, India; and
| | - Alexander von Glinski
- 1Swedish Neuroscience Institute, Seattle; and.,4Department of Trauma Surgery, BG University Hospital Bochum, Germany
| | - Ronen Blecher
- 1Swedish Neuroscience Institute, Seattle; and.,5Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Israel
| | | | - Andreas Unterberg
- 2Department of Neurosurgery, Heidelberg University Hospital, Heidelberg; and
| | - Sarah Strot
- 1Swedish Neuroscience Institute, Seattle; and
| | - Jeffrey Roh
- 1Swedish Neuroscience Institute, Seattle; and
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Issa M, Kiening KL, Unterberg AW, Scherer M, Younsi A, Fedorko S, Oskouian RJ, Chapman JR, Ishak B. Morbidity and Mortality in Patients over 90 Years of Age Following Posterior Stabilization for Acute Traumatic Odontoid Type II Fractures: A Retrospective Study with a Mean Follow-Up of Three Years. J Clin Med 2021; 10:jcm10173780. [PMID: 34501228 PMCID: PMC8432090 DOI: 10.3390/jcm10173780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Odontoid type II fractures represent the most common cervical spine injuries in the elderly. The decision for surgical treatment in very elderly patients is still controversial. The aim of this study was to assess morbidity and mortality in patients over 90 years of age undergoing CT-guided posterior stabilization for unstable odontoid type II fractures. A total of 15 patients with an acute traumatic odontoid type II fracture who received surgical treatment for unstable odontoid type II fractures were retrospectively analyzed. Complications, morbidity, and mortality as well as length of ICU and hospital stay were determined. Clinical follow-up evaluation was based on outpatient presentation and information from family members and general practitioners. Finally, we conducted a comparison of complications rates between patients over 90 years of age and patients between 65 and 89 years old with a type II odontoid fracture after CT-guided posterior stabilization in our institution. The mean age was 91.4 years. Patients were predominately female (87%). In-hospital deaths did not occur. The average length of the hospital stay was 13.4 days and 1.9 days for the ICU. Blood transfusion was necessary in two patients (13%). Two patients (13%) developed urinary tract infection, one patient (7%) a delirium, and another epistaxis (7%). One patient (7%) developed pneumonic sepsis and fully recovered within several weeks. The mean follow-up was 36 months (range 9–72 months). Implant-related complications developed in one patient (7%). Five patients died during the follow-up period, with an average time to death of 26.6 months. Postoperative bracing was not needed in any of the patients. Posterior stabilization of unstable odontoid fractures type II using CT-guided navigation in patients over 90 years of age is a safe and effective procedure with low complications and mortality rates.
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Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Karl L. Kiening
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Andreas W. Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Moritz Scherer
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Stepan Fedorko
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Rod J. Oskouian
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA; (R.J.O.); (J.R.C.)
| | - Jens R. Chapman
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA; (R.J.O.); (J.R.C.)
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
- Correspondence: ; Tel.: +49-6221-560
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Ott N, Harland A, Scaal M, König J, Bredow J, Eysel P, Müller LP, Meyer C. The role of the transversal ligament on the atlantoaxial complex - Bending forces at C1/2 flexion limits in the elderly. Clin Biomech (Bristol, Avon) 2021; 84:105329. [PMID: 33765570 DOI: 10.1016/j.clinbiomech.2021.105329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Biomechanical functionality as well as trauma mechanisms of the atlantoaxial complex are still an issue of controversy. The transverse atlantal ligament is the strongest stabilizator. The present study aimed to analyze the bending forces of the transverse atlantal ligament and of the base of the odontoid in elderly specimens. METHODS In this biomechanical study five cadaveric specimen with a mean age of 72 at death and bone mineral density measuring for 555.3 Hounsfield units on average were used. To analyze the strain of the transverse atlantal ligament and the dense base, strain gauges were used. A custom biomechanical setup was used to test each specimen at C1/2 flexion and the strain of the transverse atlantal ligament and the dens base (μm/m) were measured. FINDINGS In four out of five, a rupture of the transverse atlantal ligament was observed, the mean force required for the ligament to fall was 175 N (min. 99.8 N; 249.2 N; SD 64.7) by a mean strain of 2102.9 μm/m (min. 1953.5 μm/m; max. 2272.3 μm/m; SD 189.7). In one specimen with the lowest Hounsfield units (155), the dens base fractured before the transverse atlantal ligament ruptured and no strain could be measured at the transversal ligament during movement afterwards. INTERPRETATION The transverse atlantal ligament fails at an average of 175 N in the elderly, which is less than the value reported previously. In osteoporotic specimen the generated force to rupture the transverse atlantal ligament can fracture the dens itself.
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Affiliation(s)
- N Ott
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany.
| | - A Harland
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Martin Scaal
- Department of Anatomy, University of Cologne, Cologne, Germany
| | - J König
- Department of Orthopedic Surgery, Division of Spine Surgery, Schön-Kliniken Düsseldorf, Düsseldorf, Germany
| | - J Bredow
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - P Eysel
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - L P Müller
- Department of Trauma and Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - C Meyer
- Department of Orthopedic Surgery, Division of Spine Surgery, Schön-Kliniken Düsseldorf, Düsseldorf, Germany
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Ishak B, Dupont G, Lachkar S, Yilmaz E, Glinski AV, Altafulla J, Kikuta S, Iwanaga J, Chapman JR, Oskouian R, Tubbs RS. Update on the Biomechanics of the Craniocervical Junction-Part I: Transverse Atlantal Ligament in the Elderly. Global Spine J 2021; 11:180-186. [PMID: 32875854 PMCID: PMC7882814 DOI: 10.1177/2192568219896544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVE The transverse ligament is the strongest ligament of the craniocervical junction and plays a critical role in atlanto-axial stability. The goal of this cadaveric study, and the subsequent study (part II), was to reevaluate the force required for the transverse ligament and alar ligament to fail in a more physiological biomechanical model in elderly specimens. METHODS Twelve C1-2 specimens were harvested from fresh-frozen Caucasian cadavers with a mean age at death of 81 years (range 68-89 years). Only the transverse ligament was preserved, and the bony C1-2 complex was left intact. The dens was pulled away from the anterior arch of C1 using a strength test machine that applies controlled increasing force. After testing, the axis was split in half to check for hidden pathologies and osteoporosis. The differences in the failure force between sex and age groups (group 1: <80 years, group 2: >80 years) were compared. RESULTS The mean force required for the transverse ligament to fail was 236.2 ± 66 N (range 132-326 N). All but 2 specimens had significant osteoporotic loss of trabecular bone. No significant differences between sex and age groups were found. CONCLUSIONS The transverse ligament's failure in elderly specimens occurred at an average force of 236 N, which was lower than that reported in the previous literature. The ligament's failure force in younger patients differs and may be similar to the findings published to date.
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Affiliation(s)
- Basem Ishak
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,Heidelberg University Hospital, Heidelberg, Germany,Basem Ishak, Swedish Neuroscience Institute, Seattle, WA 98122, USA.
| | | | | | - Emre Yilmaz
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | | | | | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | | | - Rod Oskouian
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | - R. Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA,St. George’s University, Grenada, West Indies
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Kirnaz S, Gebhard H, Wong T, Nangunoori R, Schmidt FA, Sato K, Härtl R. Intraoperative image guidance for cervical spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:93. [PMID: 33553386 PMCID: PMC7859826 DOI: 10.21037/atm-20-1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intraoperative image-guidance in spinal surgery has been influenced by various technological developments in imaging science since the early 1990s. The technology has evolved from simple fluoroscopic-based guidance to state-of-art intraoperative computed tomography (iCT)-based navigation systems. Although the intraoperative navigation is more commonly used in thoracolumbar spine surgery, this newer imaging platform has rapidly gained popularity in cervical approaches. The purpose of this manuscript is to address the applications of advanced image-guidance in cervical spine surgery and to describe the use of intraoperative neuro-navigation in surgical planning and execution. In this review, we aim to cover the following surgical techniques: anterior cervical approaches, atlanto-axial fixation, subaxial instrumentation, percutaneous interfacet cage implantation as well as minimally invasive posterior cervical foraminotomy (PCF) and unilateral laminotomy for bilateral decompression. The currently available data suggested that the use of 3D navigation significantly reduces the screw malposition, operative time, mean blood loss, radiation exposure, and complication rates in comparison to the conventional fluoroscopic-guidance. With the advancements in technology and surgical techniques, 3D navigation has potential to replace conventional fluoroscopy completely.
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Affiliation(s)
- Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Harry Gebhard
- Department of Surgery, Canton Hospital Baden, Switzerland.,Department of Trauma, University Hospital Zurich, University of Zurich, Switzerland
| | - Taylor Wong
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Raj Nangunoori
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Franziska Anna Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Kosuke Sato
- Hospital for Special Surgery, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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Catalino MP, Pate V, Stürmer T, Bhowmick DA. Comparative Propensity-Weighted Mortality After Isolated Acute Traumatic Axis Fractures in Older Adults. Geriatr Orthop Surg Rehabil 2020; 11:2151459320911867. [PMID: 32284902 PMCID: PMC7133078 DOI: 10.1177/2151459320911867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/27/2019] [Accepted: 01/16/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In older patients with axis fractures, the survival benefit from surgery is unclear due to high baseline mortality. Comparative effectiveness research can provide evidence from population level cohorts. Propensity weighting is the preferred methodology for reducing bias when analyzing national administrative cohort data for these purposes but has not yet been utilized for this important surgical conundrum. We estimate the effect of surgery on mortality after isolated acute traumatic axis fracture in older adults. MATERIALS AND METHODS We used a retrospective population-based cohort of Medicare patients and generated a propensity score-weighted nonsurgical cohort and compared mortality with and without surgery. This balanced the comorbid conditions of the treatment groups. Incident fractures were defined using a predetermined algorithm based on enrollment, code timing, and billing location. The primary outcome was adjusted all-cause 1-year mortality. RESULTS From 12 372 beneficiaries with 1-year continuous enrollment and a coded axis fracture, 2676 patients met final inclusion/exclusion criteria. Estimated incidence was 16.5 per 100 000 person-years overall in 2014 (95% confidence interval [CI]: 15.0-18.0) and was stable from 2008 through 2014. Patients with axis fracture had a mean age of 82.8 years, 30.2% were male, and 91.9% were Caucasian. Mortality was 3.8 times higher (CI 3.6-4.1) compared with the general population of older US adults. Propensity-weighted mortality at 1 year for nonsurgical patients was 26.7 of 100 (CI: 24.5-29.0). Mortality for surgical patients was significantly lower (19.7/100; CI 14.5-25.0). Risk difference was 7.0 fewer surgical deaths per 100 patients (CI: 1.3-12.7). Surgical patients aged 65 to 74 years had the largest difference in mortality with 11.2 fewer deaths per 100 (CI: 1.1-21.3). DISCUSSION Patients with axis fractures are predominantly older Caucasian women and have a higher mortality rate than the general population. Propensity-weighted mortality at 1-year was lower in the surgical patients with the largest risk difference occurring in patients 65 to 74 years old. CONCLUSIONS Surgery may provide an independent survival benefit in patients aged 65 to 75 years, and the mortality difference diminishes thereafter.
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Affiliation(s)
| | - Virginia Pate
- Department of Epidemiology, UNC Gillings School of Global Public Health, NC, USA
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public Health, NC, USA
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Ishak B, Bajwa AA, Schneider T, Tubbs RS, Iwanaga J, Ramey WL, Unterberg AW, Kiening KL. Early Complications and Cement Leakage in Elderly Patients Who Have Undergone Intraoperative Computed Tomography (CT)-Guided Cement Augmented Pedicle Screw Placement: Eight-Year Single-Center Experience. World Neurosurg 2019; 128:e975-e981. [DOI: 10.1016/j.wneu.2019.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/12/2022]
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14
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Safety and performance of a novel articulating cage for transforaminal lumbar interbody fusion in the setting of intraoperative spinal navigation. Clin Neurol Neurosurg 2019; 183:105391. [PMID: 31254909 DOI: 10.1016/j.clineuro.2019.105391] [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: 02/27/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) has been described as safe and effective procedure for the treatment of low back pain. However, only a few retrospective articles describing articulating cages exist in literature. The aim of this study was to assess the clinical and radiological results, as well as patient safety and complications by using a novel articulating TLIF cage. PATIENTS AND METHODS Out of 50 patients, 49 were included in this prospective study. Under computer tomography (CT) guided spinal navigation the TLIF procedure was performed. Clinical outcome scores visual analog scale (VAS), Oswestry disability index (ODI) and short form-36 health survey questionnaire (SF-36) were obtained preoperatively, 6 and 12 months after surgery. Radiological data were acquired preoperatively, after 6 weeks, as well as 6 and 12 postoperatively and included measurements for disc height (anterior/posterior), foraminal height, segmental and global lumbar lordosis. RESULTS 71% of the included patients have undergone previous lumbar surgery. In total, 80 SYNCHRO® cages have been implanted. The clinical results revealed a highly significant improvement of VAS, ODI and SF-36 after 6 and 12 months, compared to baseline levels (p < 0.05). Radiological analysis revealed a significant increase in anterior and posterior disc height, foraminal height, segmental and global lumbar lordosis postoperatively (p < 0.05). 47 out 49 patients (96%) showed evidence for fusion at the 12 months follow-up. Cage dislocation was found in 1 of 80 implanted cages (1%), which required revision surgery. Two dural tears occurred intraoperatively, which have been fixed. Another two patients needed surgical revision due to infection. The overall complication rate was 10% (n = 5/49). CONCLUSIONS The current study delineates satisfactory clinical and radiological results by using a novel articulating TLIF-cage. The implant-related complication rate was acceptable with low revision rate.
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Natella L, Bronsard N, Allia J, Hekayem L, Euller-Ziegler L, De Peretti F, Breuil V. A Case Series Study of Odontoid Fracture in the Elderly: A Severe Fracture Occurring Most Frequently in Osteoporotic Subjects. JBMR Plus 2019; 3:e10076. [PMID: 31044178 PMCID: PMC6478580 DOI: 10.1002/jbm4.10076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022] Open
Abstract
The WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low‐energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X‐ray absorptiometry, and laboratory tests. Osteoporosis was defined as a T‐score ≤ −2.5 on at least one site, or a bone fragility fracture associated with a T‐score ≤ −1 at one site. Thirty‐three patients were hospitalized for OF, 30 of them as a consequence of a low‐energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow‐up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow‐up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow‐up (n = 10), one was dead and nine lived at home. At 12 months (n = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low‐energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger‐scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Lauren Natella
- Rheumatology Universite Cote d'Azur Centre Hospitalier Universitaire (CHU) de Nice Nice France
| | - Nicolas Bronsard
- Orthopaedic Trauma and Spine Surgery Universite Cote d'Azur Institut Universitaire de l'Appareil Locomoteur et du Sport Nice France
| | - Jeremy Allia
- Orthopaedic Trauma and Spine Surgery Universite Cote d'Azur Institut Universitaire de l'Appareil Locomoteur et du Sport Nice France
| | - Laurent Hekayem
- Orthopaedic Trauma and Spine Surgery Universite Cote d'Azur Institut Universitaire de l'Appareil Locomoteur et du Sport Nice France
| | - Liana Euller-Ziegler
- Rheumatology Universite Cote d'Azur Centre Hospitalier Universitaire (CHU) de Nice Nice France
| | - Fernand De Peretti
- Orthopaedic Trauma and Spine Surgery Universite Cote d'Azur Institut Universitaire de l'Appareil Locomoteur et du Sport Nice France
| | - Véronique Breuil
- Rheumatology Universite Cote d'Azur Centre Hospitalier Universitaire (CHU) de Nice Nice France.,Commission for Atomic Energy and Alternative Energies (CEA)/Directorate of Basic Research (DRF)/Biosciences and Biotechnologies Institute of Aix-Marseille (BIAM) Unités Mixtes de Recherche (UMR) E4320 Transporters Imaging and Radiotherapy in Oncology (TIRO)-Mécanismes biologiques des Altérations du Tissu Osseux (MATOs) Nice France
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Accuracy and revision rate of intraoperative computed tomography point-to-point navigation for lateral mass and pedicle screw placement: 11-year single-center experience in 1054 patients. Neurosurg Rev 2018; 42:895-905. [PMID: 30569212 DOI: 10.1007/s10143-018-01067-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/07/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
High accuracy in intraoperative computed tomography (iCT) navigation utilizing an intraoperatively acquired dataset for screw placement in the spine has been reported in the literature. To further improve the accuracy and counteract any intraoperative movement of predefined registration points, we introduce an iCT point-to-point navigation, where marker screws are inserted intraoperatively to increase patient safety. In all, 1054 patients who underwent iCT point-to-point navigation for lateral mass and pedicle screw placement were retrospectively analyzed between 09/2005 and 09/2016. Implant-related complications such as screw misplacement, screw loosening, and revision rate were determined. Furthermore, we investigated the rate of complications and the clinical outcome. In total, 6059 screws were inserted in 1054 patients. There were 553 (52.5%) female and 501 (47.5%) male patients. Average age was 63.5 years, mean BMI 27.5 (SD 13.9). Here, 1427 (23.5%) screws were inserted in the cervical, 995 (16.4%) in the thoracic, 3167 (52.3%) in the lumbar, and 470 (7.8%) in the sacral spine. Eight patients required a revision procedure for screw misplacement (0.8%). Total screw misplacement rate was 0.3% (16/6059). With the use of reference markers in iCT-based, spinal, point-to-point navigation, we achieved a high accuracy of screw placement with a low revision rate (0.8%) and a total screw misplacement rate of 0.3%.
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Robinson AL, Olerud C, Robinson Y. Surgical treatment improves survival of elderly with axis fracture-a national population-based multiregistry cohort study. Spine J 2018; 18:1853-1860. [PMID: 29649609 DOI: 10.1016/j.spinee.2018.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/27/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Fractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically. PURPOSE We aimed to analyze whether surgery improves survival of elderly with C2 fractures. STUDY DESIGN/SETTING An observational population-based longitudinal multi-registry study was carried out. PATIENT SAMPLE Swedish Patient Registry 1997 to 2014 and Swedish Cause of Death Registry 1997 to 2014 served as source of patient sample. OUTCOME MEASURES Survival after C2 fracture according to non-surgical and surgical treatment was the outcome measure. METHODS We included all patients treated for the primary diagnosis of C2 fracture (10th revision of the International Statistical Classification of Diseases and Related Health Problems or ICD-10: S12.1) at an age ≥70 years and receiving treatment at a health-care facility. Non-surgical treatment comprises cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan-Meier method. Comorbidity was determined using the Charlson Comorbidity Index. RESULTS Of the included 3,375 elderly patients with C2 fractures (43% men, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender, and year of treatment. The 1-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<.001, relative risk reduction=11%). Adjusted for age, gender, comorbidity, and year of injury, surgically treated patients had greater survival than non-surgically treated patients (hazard ratio=0.88, 95% confidence interval: 0.79-0.97). Among those above 88 years of age (95% confidence interval: 85-92), surgical treatment lost its effect on survival. CONCLUSIONS Despite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.
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Affiliation(s)
- Anna-Lena Robinson
- Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89 Upplands-Väsby, Sweden; Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden.
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Research and Development, Swedish Armed Forces Centre for Defence Medicine, Box 5155, 425 05 Västra Frölunda, Sweden
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Wang H, Xue R, Wu L, Ding W, Ma L. Comparison of clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures. Medicine (Baltimore) 2018; 97:e11452. [PMID: 30024518 PMCID: PMC6086456 DOI: 10.1097/md.0000000000011452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to compare clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures, and hope to provide references in decision making and surgical planning for both spinal surgeons and surgically treated patients.This is a retrospective study. By retrieving the medical records from January 2005 to July 2015 in our hospital, 53 Type II odontoid fracture patients were reviewed. According to the instrumentation type, patients were divided into 2 groups: Wiring group and Screw group. Three categorized factors were analyzed statistically: patient characteristics: age, body mass index, preoperative neurological status, duration, complicated injuries; surgical variables: surgery time, blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, pain at the bone donor area, instrumentation failure, revision rate; and radiographic parameters: preoperative and final follow-up data of C0-2 curvature, C2-7 curvature, C2-C7 sagittal vertical axis, C7 slope, fracture classification, separation, and displacement of odontoid fracture, fusion rate. An additional comparison of surgical outcomes was done, including patient satisfaction, visual analog scale score for neck pain, neck stiffness, medical expense.There was no statistically significant difference between the 2 groups in patient characteristics of age, sex, body mass index, preoperative neurological status, duration, and complicated injuries. No statistically significant difference was noted in surgical variables of blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, bone harvested zone pain, instrumentation failure, revision rate. The surgery time was shorter in Wiring group than that in Screw group, with a statistically significant difference. We noted no significant difference between the 2 groups when comparing radiographic parameters of preoperative and final follow-up data of C0-2 curvature, C2-C7 sagittal vertical axis, fracture classification, the separation and displacement of odontoid fracture, and fusion rate. Although we noted no significant difference in preoperative C2-7 curvature and C7 slope, the final follow-up data showed that C2-7 curvature and C7 slope were smaller in Wiring group than that in Screw group. We noted no significant difference in visual analog scale score, neck stiffness, and neurological status at final follow-up. The medical expense was less in Wiring group; the patient satisfaction was lower in the Wiring group than that in the Screw group.The modified Gallie graft fusion-wiring technique provided solid fusion and stabilization for patients with Type II odontoid fractures, Gallie graft fusion-wiring resulted in less surgery time, less medical expense, but lower patient satisfaction when compared with the posterior cervical screw constructs.
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Yue JK, Ordaz A, Winkler EA, Deng H, Suen CG, Burke JF, Chan AK, Manley GT, Dhall SS, Tarapore PE. Predictors of 30-Day Outcomes in Octogenarians with Traumatic C2 Fractures Undergoing Surgery. World Neurosurg 2018; 116:e1214-e1222. [PMID: 29886301 DOI: 10.1016/j.wneu.2018.05.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Predictors of surgical outcomes following traumatic axis (C2) fractures in octogenarians remain undercharacterized. METHODS Patients age ≥80 years undergoing cervical spine surgery following traumatic C2 fractures were extracted from the National Sample Program of the National Trauma Data Bank (2003-2012). Outcomes include overall inpatient complications, individual complications with an incidence >1%, hospital length of stay (HLOS), discharge disposition, and mortality. Demographics, comorbidities, and injury predictors were analyzed using multivariable regression. Odds ratios (OR), mean differences, and 95% confidence intervals (CIs) were calculated. Statistical significance was assessed at P < 0.05. RESULTS The cohort of 442 patients was 48.6% male and had a mean age of 84.3 ± 2.7 years. The distribution of admissions was 42.3% to the hospital floor, 40.3% to the intensive care unit (ICU), 7.7% to telemetry, 2.0% to the operating room, and 7.7% to other/unknown. Mortality was 9.7%, mean HLOS was 13.1 ± 9.2 days, the rate of complications was 38.5%, and 81.5% of survivors were discharged to a nonhome facility. Injury severity was predictive of mortality and overall complications. History of bleeding disorder/coagulopathy predicted mortality (OR, 4.02; 95% CI, 1.07-15.05), overall complications (OR, 3.01; 95% CI, 1.09-8.32), cardiac arrest (OR, 8.19; 95% CI, 1.06-63.54), and renal complications (OR, 10.36; 95% CI, 2.13-50.38). History of congestive heart failure predicted mortality (OR, 3.10; 95% CI, 1.10-8.69). ICU admission (vs. floor) predicted overall complications (OR, 2.01; 95% CI, 1.23-3.27) and pneumonia (OR, 4.65; 95% CI, 1.91-11.30). Telemetry admission (vs. floor) predicted unplanned intubation (OR, 7.76; 95% CI, 1.24-48.49). CONCLUSIONS In this cohort of octogenarians undergoing surgery for traumatic C2 fracture, injury severity and a history of bleeding disorder/coagulopathy were identified as risk factors for inpatient complications and mortality. Heightened surveillance should be considered for ICU and/or telemetry admissions for the development of complications. These findings warrant consideration by the clinician, patient, and family to inform clinical decisions and goals of care.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Angel Ordaz
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Catherine G Suen
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
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20
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Ottenhausen M, Alalade AF, Rumalla K, Nair P, Baaj A, Hartl R, Kacker A, Greenfield JP, Anand VK, Schwartz TH. Quality of Life After Combined Endonasal Endoscopic Odontoidectomy and Posterior Suboccipital Decompression and Fusion. World Neurosurg 2018; 116:e571-e576. [PMID: 29775769 DOI: 10.1016/j.wneu.2018.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Basilar invagination can result from systemic diseases that can weaken structural integrity of the craniocervical junction. Definitive treatment often requires ventral decompression and posterior decompression and fusion. Endonasal odontoidectomy is a relatively new minimal access procedure; quality of life (QOL) after this procedure has not been reported. METHODS We reviewed a consecutive database of endonasal odontoidectomy cases and identified patients having posterior decompression and fusion. Two QOL questionnaires were administered postoperatively: Sino-Nasal Outcome Test and 36-Item Short Form Survey. Comparisons with other endonasal or Chiari procedures were performed. RESULTS The study comprised 14 patients; 79% had Chiari malformation in addition to basilar invagination. Mean follow-up was 17.2 months. Symptomatic improvement occurred in 78.6% after surgery. Average postoperative Sino-Nasal Outcome Test scores were 39.2 ± 17.93, with worst scores in areas related to fatigue and sleep patterns but not nasal function. 36-Item Short Form Survey scores were lower in areas of physical function and general health but better for emotional health and pain. Compared with patients undergoing Chiari malformation surgery without endonasal odontoid resection or fusion, patients undergoing odontoidectomy had higher QOL in areas of role emotional, emotional well-being, and pain but worse QOL in general health and role physical. CONCLUSIONS Patients undergoing posterior decompression and fusion with endonasal odontoidectomy do well after surgery with respect to nasal function and emotional health. Patients who also have severe basilar invagination associated with systemic diseases demonstrate reduced QOL after surgery in areas of physical function and sleep leading to fatigue, irritability, and concentration difficulty, likely related to their systemic disease.
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Affiliation(s)
- Malte Ottenhausen
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Andrew F Alalade
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Prakash Nair
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Ali Baaj
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Hartl
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Neuroscience, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA.
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21
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Salunke P, Karthigeyan M, Sunil N, Rangan V. ‘Congenital anomalies of craniovertebral junction presenting after 50 years of age’: An oxymoron or An unusual variation? Clin Neurol Neurosurg 2018; 165:15-20. [DOI: 10.1016/j.clineuro.2017.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
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