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Shi Z, Mao Z, Xue S, Chen G, Li S. What is the relationship between health-related quality of life among scoliosis patients and their caregiver burden? A cross-sectional study in China. BMC Psychol 2023; 11:346. [PMID: 37858224 PMCID: PMC10588232 DOI: 10.1186/s40359-023-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Caregivers play a vital role in the recovery of scoliosis patients, but limited studies evaluate the caregivers' HRQoL and burden in health care. This study aimed to explore the health-related quality of life (HRQoL) of scoliosis patients and their caregivers, and identify the factors influencing caregiver burden in Eastern China. METHODS This cross-sectional study was conducted from August 2018 to January 2019 at the Shandong Provincial Hospital, Jinan, China. The HRQoL of scoliosis patients was measured by the Scoliosis Research Society-22r (SRS-22r), five-level EQ-5D (EQ-5D-5L) and Child Health Utility 9D (CHU9D). The caregivers' questionnaires consist of the EQ-5D-5L, WHO-five wellbeing index (WHO-5), 22-item Zarit Caregiver Burden Interview (ZBI-22) and Social Support Rating Scale (SSRS). Spearman correlation coefficients were used to estimate the relationship among caregivers' burden, social support, HRQoL, and SWB. Cohen's effect size (Cohen's d) was used to assess the ZBI-22 total score between different groups. Multiple stepwise hierarchical linear regression models were conducted to assess the associated factors of caregiver burden. RESULTS There were 59 scoliosis patients and their caregivers (n = 59) included in the analysis. The mean health state utility of adolescent scoliosis patients (n = 39) was 0.718 (95%CI: 0.654, 0.782) based on CHU9D and adult scoliosis patients (n = 20) was 0.663 (95%CI: 0.471, 0.855) based on EQ-5D-5L. The mean health state utility of male scoliosis patients (0.792/0.667) was higher than females (0.681/0.662) based on CHU9D and EQ-5D-5L (p > 0.05), respectively. The ZBI-22 total score of scoliosis patients' caregivers was 27.86 (SD: 20.59). Scoliosis patients' HRQoL was significantly inversely correlated with caregiver burden, and the HRQoL and subjective wellbeing (SWB) of caregivers were moderately and inversely correlated with caregiver burden. The regression results showed that the patients' age and caregivers' SWB were key characteristics associated with caregiver burden. CONCLUSIONS The caregiver burden of adolescent patients was higher than that of adult patients, and the satisfaction rate of adolescent scoliosis patients was higher than that of adult scoliosis patients. Improving the functional state of scoliosis patients and providing appropriate nursing practice education from health professionals would be necessary to effectively improve caregivers SWB and alleviate caregiver burden.
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Affiliation(s)
- Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, 250012, Jinan, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, 2000, Belgium
| | - Shiwen Xue
- National Center for Respiratory Medicine, Guangzhou, 510000, China
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
- National Clinical Research Center for Respiratory Disease, Guangzhou, 510000, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510000, China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, 250012, Jinan, China.
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Zileli M, Akıntürk N, Yaman O. Complications of adult spinal deformity surgery: A literature review. J Craniovertebr Junction Spine 2022; 13:17-26. [PMID: 35386240 PMCID: PMC8978850 DOI: 10.4103/jcvjs.jcvjs_159_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.
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Varshneya K, Pangal DJ, Stienen MN, Ho AL, Fatemi P, Medress ZA, Herrick DB, Desai A, Ratliff JK, Veeravagu A. Postoperative Complication Burden, Revision Risk, and Health Care Use in Obese Patients Undergoing Primary Adult Thoracolumbar Deformity Surgery. Global Spine J 2021; 11:345-350. [PMID: 32875891 PMCID: PMC8013946 DOI: 10.1177/2192568220904341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN This is a retrospective cohort study using a nationally representative administrative database. OBJECTIVE To identify the impact of obesity on postoperative outcomes in patients undergoing thoracolumbar adult spinal deformity (ASD) surgery. BACKGROUND The obesity rate in the United States remains staggering, with approximately one-third of all Americans being overweight or obese. However, the impact of elevated body mass index on spine surgery outcomes remains unclear. METHODS We queried the MarketScan database to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2016. Patients were then stratified by whether or not they were diagnosed as obese at index surgical admission. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between obese and nonobese patients. Patients <18 years and those with any prior history of trauma or tumor were excluded from this study. Baseline demographics and comorbidities, postoperative complication rates, and short- and long-term reoperation rates were determined. RESULTS A total of 7423 patients met the inclusion criteria of this study, of whom 597 (8.0%) were obese. Initially, patients with obesity had a higher 90-day postoperative complication rate than nonobese patients (46.1% vs 40.8%, P < .05); however, this difference did not remain after PSM. Revision surgery rates after 2 years were similar across the 2 groups following primary surgery (obese, 21.4%, vs nonobese, 22.0%; P = .7588). Health care use occurred at a higher rate among obese patients through 2 years of long-term follow-up (obese, $152 930, vs nonobese, $140 550; P < .05). CONCLUSION Patients diagnosed with obesity who underwent ASD surgery did not demonstrate increased rates of complications, reoperations, or readmissions. However, overall health care use through 2 years of follow-up after index surgery was higher in the obesity cohort.
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Affiliation(s)
| | | | - Martin N. Stienen
- Stanford University School of Medicine, Stanford, CA, USA,University of Zurich, Zurich, Switzerland
| | - Allen L. Ho
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Atman Desai
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Anand Veeravagu
- Stanford University School of Medicine, Stanford, CA, USA,Anand Veeravagu, Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Edwards Bldg, R281, Stanford, CA 94305, USA.
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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. 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 2018; 27:2272-2284. [DOI: 10.1007/s00586-018-5535-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 2018; 42:319-336. [PMID: 29411177 DOI: 10.1007/s10143-018-0951-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
We conducted a systematic review with meta-analysis and qualitative synthesis. This study aims to characterize pseudarthrosis after long-segment fusion in spinal deformity by identifying incidence rates by etiology, risk factors for its development, and common features. Pseudarthrosis can be a painful and debilitating complication of spinal fusion that may require reoperation. It is poorly characterized in the setting of spinal deformity. The MEDLINE, EMBASE, and Cochrane databases were searched for clinical research including spinal deformity patients treated with long-segment fusions reporting pseudarthrosis as a complication. Meta-analysis was performed on etiologic subsets of the studies to calculate incidence rates for pseudarthrosis. Qualitative synthesis was performed to identify characteristics of and risk factors for pseudarthrosis. The review found 162 articles reporting outcomes for 16,938 patients which met inclusion criteria. In general, the included studies were of medium to low quality according to recommended reporting standards and study design. Meta-analysis calculated an incidence of 1.4% (95% CI 0.9-1.8%) for pseudarthrosis in adolescent idiopathic scoliosis, 2.2% (95% CI 1.3-3.2%) in neuromuscular scoliosis, and 6.3% (95% CI 4.3-8.2%) in adult spinal deformity. Risk factors for pseudarthrosis include age over 55, construct length greater than 12 segments, smoking, thoracolumbar kyphosis greater than 20°, and fusion to the sacrum. Choice of graft material, pre-operative coronal alignment, post-operative analgesics, and sex have no significant impact on fusion rates. Older patients with greater deformity requiring more extensive instrumentation are at higher risk for pseudarthrosis. Overall incidence of pseudarthrosis requiring reoperation is low in adult populations and very low in adolescent populations.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine whether an association exists between high body mass index (BMI>25 kg/m) and surgical outcomes in revision adult scoliosis patients. SUMMARY OF BACKGROUND DATA Obesity is thought to be associated with increased surgical complications and inferior clinical outcomes in adults. There are no studies analyzing the effect of obesity on surgical outcomes in revision patients for adult scoliosis. METHODS Forty-five consecutive revision adult scoliosis patients (35 women and 10 men; mean age, 62.7±9.3 y) with a minimum follow-up of 2 years were included in this study. Patients were divided into 2 groups according to BMI: overweight (BMI≥25 kg/m, n=27) and nonoverweight (<25 kg/m, n=18). Radiographic measures, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), as well as comorbidities and complications were reviewed and compared at preoperative and 2-year follow-up. RESULTS No significant differences in surgical methods, complication rates, or radiographic measures were found between the 2 groups except for the greater preoperative and final follow-up thoracic kyphosis in the overweight group (P<0.05). A higher comorbidity rate of circulatory disorders (33.3% vs. 0%, P=0.018) and diabetes (25.9% vs. 0%, P=0.053) was observed in the overweight group, as well as a higher preoperative VAS score (7.1±1.7 vs. 5.2±2.9, P=0.031). At 2-year follow-up, VAS and ODI improvements for both groups showed significant and similar improvement from preoperative (P<0.01). CONCLUSIONS Overweight revision adult scoliosis patients had higher thoracic kyphosis and more significant preoperative pain compared with normal-weight individuals. Overweight patients also had significantly higher rates of medical comorbidities. However, BMI did not affect the functional outcome of surgical correction or perioperative complication rates. Overweight patients benefited from surgery just as much as nonoverweight patients at 2-year follow-up.
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Matusik E, Durmala J, Matusik P. Association of Body Composition with Curve Severity in Children and Adolescents with Idiopathic Scoliosis (IS). Nutrients 2016; 8:71. [PMID: 26828519 PMCID: PMC4772035 DOI: 10.3390/nu8020071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/28/2015] [Accepted: 01/19/2016] [Indexed: 01/05/2023] Open
Abstract
The link between scoliotic deformity and body composition assessed with bioimpedance (BIA) has not been well researched. The objective of this study was to correlate the extent of scoliotic-curve severity with the anthropometrical status of patients with idiopathic scoliosis (IS) based on standard anthropometric measurements and BIA. The study encompassed 279 IS patients (224 girls/55 boys), aged 14.21 ± 2.75 years. Scoliotic curve severity assessed by Cobb's angle was categorized as moderate (10°-39°) or severe (≥40°). Corrected height, weight, waist and hip circumferences were measured and body mass index (BMI), corrected height z-score, BMI Z-score, waist/height ratio (WHtR) and waist/hip ratio (WHR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM) and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. The mean Cobb angle was 19.96° ± 7.92° in the moderate group and 52.36° ± 12.54° in the severe group. The corrected body heights, body weights and BMIs were significantly higher in the severe IS group than in the moderate group (p < 0.05). Significantly higher FAT and lower FFM and PMM were observed in the severe IS group (p < 0.05). The corrected heights and weights were significantly higher in patients with severe IS and normal weight (p < 0.01). Normal and overweight patients with a severe IS had significantly higher adiposity levels assessed by FAT, FFM and PMM for normal and BMI, BMI z-score, WHtR, FAT and PMM for overweight, respectively. Overweight IS patients were significantly younger and taller than underweight and normal weight patients. The scoliotic curve severity is significantly related to the degree of adiposity in IS patients. BMI z-score, WHtR and BIA seem to be useful tools for determining baseline anthropometric characteristics of IS children.
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Affiliation(s)
- Edyta Matusik
- Department of Rehabilitation, School of Health Sciences, Medical University of Silesia, Ziolowa 45-47, 40-635 Katowice, Poland.
| | - Jacek Durmala
- Department of Rehabilitation, School of Health Sciences, Medical University of Silesia, Ziolowa 45-47, 40-635 Katowice, Poland.
| | - Pawel Matusik
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Medykow 16; 40-752 Katowice, Poland.
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Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP. A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent. Spine Deform 2015; 3:575-594. [PMID: 27927561 DOI: 10.1016/j.jspd.2015.04.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making. METHODS A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy). RESULTS Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy. CONCLUSIONS A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
| | - Alp Yurter
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, 4921 Parkview Place, A 12, St. Louis, MO 63110, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, 3182 SW Sam Jackson Park Rd; Ortho Dept MC: OP31, Portland, OR 97239, USA
| | - Shay Bess
- Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA
| | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779 - Department of Neurosurgery, San Francisco, CA 94143, USA
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Abstract
STUDY DESIGN Retrospective cohort analysis of prospectively collected data. OBJECTIVE To determine whether an association exists between body mass and surgical outcomes in patients with degenerative scoliosis after long instrumented spinal arthrodesis (≥ 4 discs). SUMMARY OF BACKGROUND DATA Obesity is thought to be associated with increased surgical complications and inferior clinical outcomes in adults. There are no studies analyzing the effect of obesity on surgical outcomes in patients with degenerative scoliosis after long instrumented spinal arthrodesis. METHODS Eighty-four consecutive patients with degenerative scoliosis (69 females and 15 males; mean age, 68.6 ± 8.0 yr) with a minimum follow-up of 2 years were included in this study. Patients were divided into 3 groups according to body mass index (BMI): obese (BMI ≥ 30 kg/m², n = 19), overweight (BMI = 25-29.9 kg/m², n = 35), and normal weight (BMI < 25 kg/m², n = 30). Radiographical measures, Oswestry Disability Index, visual analogue scale score, as well as comorbidities and complications were reviewed and analyzed for all patients preoperatively and at 1- and 2-year follow-ups. RESULTS Compared with the normal weight group, no significant differences in surgical methods, comorbidities, complication rates, curve correction, or radiographical measures were found in the obese and overweight groups, except for a greater preoperative lumbar lordosis in the overweight group (-40.3° ± 13.8° vs. -26.0° ± 18.9°, P < 0.05). At 2-year follow-up, Oswestry Disability Index and visual analogue scalescores improved significantly in all groups compared with preoperatively (P < 0.01). The changes of Oswestry Disability Index and visual analogue scalescores from preoperatively to final follow-up were similar in the 3 groups (P > 0.05). CONCLUSION Obesity did not affect the amount of deformity correction and did not increase comorbidities and postoperative complication rates. Overweight patients had a greater lumbar lordosis before surgery than normal weight patients. Obese and overweight patients benefited from surgery just as much as normal weight patients at 2-year follow-up.
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Tyrakowski M, Kotwicki T, Czubak J, Siemionow K. Calculation of corrected body height in idiopathic scoliosis: comparison of four methods. 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 2014; 23:1244-50. [PMID: 24687626 DOI: 10.1007/s00586-014-3275-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the study was to analyze four radiographic methods of calculating the loss of body height associated with scoliosis. METHODS Thirty patients with right thoracic idiopathic scoliosis were examined with standing postero-anterior radiographs. Cobb angles of the upper thoracic, main thoracic and lumbar curves were measured. The loss of body height due to scoliosis was measured directly on the radiographs and then calculated using the methods of Bjure, Kono, Stokes and Ylikoski, respectively. The reproducibility of calculations was tested. Detailed analysis of two patients with similar Cobb angle but different trunk height was performed. RESULTS The mean Cobb angle of the main thoracic curve was 46° (21°-74°). The mean loss of body height was 23 mm (11-43 mm) calculated by method of Bjure, 7 mm (-24 to 46 mm) by Kono, 20 mm (5-47 mm) by Stokes, 14 mm (3-36 mm) by Ylikoski, versus 18 mm (3-50 mm) measured directly on radiographs. The overall difference between the loss of body heights was significant (p < 0.0001), with significant differences in pairs for: Bjure versus Kono (p < 0.0001), Stokes versus Kono (p = 0.0002), Kono versus measured (p = 0.0061) and Bjure versus Ylikoski (p = 0.0386). Strong linear correlation between the methods was found (r ≥ 0.92; p < 0.0001). High reproducibility of height loss calculations was noticed. The two patients with similar Cobb angle and different trunk height revealed similar height loss calculated, while different loss measured on radiographs. CONCLUSIONS There existed no overall agreement between the four methods of calculation of the loss of body height associated with scoliosis. Calculations based on the Cobb angle produced inaccuracy and could be supplemented with data considering trunk size.
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Affiliation(s)
- Marcin Tyrakowski
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, The Centre of Postgraduate Medical Education in Warsaw, Konarskiego 13, 05-400, Otwock, Poland,
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Low body mass index in adolescent idiopathic scoliosis: relationship with pre- and postsurgical factors. Spine (Phila Pa 1976) 2014; 39:140-8. [PMID: 24153169 DOI: 10.1097/brs.0000000000000081] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the association between low preoperative body mass index (BMI) and outcome of spinal fusion in adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Several studies report a lower weight and BMI in untreated subjects with AIS than nonscoliotic age-matched controls. However, very little is known about the clinical impact of low BMI on pre- or postsurgical parameters in this patient group. METHODS Seventy-seven eligible patients with AIS who underwent 1-stage posterior spinal fusion and correction at 2 tertiary centers (January 2010-April 2012) were included. Preoperative weight, corrected height, and BMI values were converted to z scores using the British 1990 growth reference data. Relationships between anthropometric indices and comorbidities, laboratory blood data, radiographical outcomes, length of hospital stay, and perioperative complications were examined, and the independent factors associated with low BMI (z score < -1) evaluated using binary logistic regression analysis. RESULTS In this AIS cohort (mean age, 15.04 yr; n = 72 females), 21 subjects (27.3%) had a low preoperative BMI; of these, 5 cases (6.5%) were considered severely thin. Lower BMI and weight z scores correlated with a greater percent correction of thoracic curves (rs = -0.287 and rs = -0.257, respectively, P < 0.05). In both the univariate and multivariate regression analysis, low BMI was significantly associated with preoperative asthma incidence (adjusted odds ratio 5.33, P = 0.023) and prolonged prothrombin time (adjusted odds ratio 4.53, P = 0.027), in addition to postoperative ileus development (adjusted odds ratio 11.96, P = 0.019). Preoperative Cobb angle, estimated intraoperative blood loss and length of hospital stay did not significantly differ between the BMI groups. CONCLUSION Significantly increased preoperative coagulation abnormality and asthma incidence as well as a greater percent correction of thoracic curves were associated with low BMI in this series. It was also found that postoperative ileus was independently associated with low BMI. LEVEL OF EVIDENCE 3.
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Mesfin A, Lenke LG, Bridwell KH, Jupitz JM, Akhtar U, Fogelson JL, Hershman S, Kim HJ, Koester LA. Weight Change and Clinical Outcomes Following Adult Spinal Deformity Surgery in Overweight and Obese Patients. Spine Deform 2013; 1:377-381. [PMID: 27927396 DOI: 10.1016/j.jspd.2013.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/23/2013] [Accepted: 07/04/2013] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Retrospective comparative study. SUMMARY OF BACKGROUND DATA The effect of spine surgery on postoperative weight loss or weight gain in overweight and obese spinal deformity patients is unknown. OBJECTIVE To evaluate the postoperative outcomes and weight changes in adult patients undergoing spinal deformity surgery. MATERIALS AND METHODS A total of 104 adult patients undergoing primary spinal deformity surgery were enrolled. All patients had a minimum 2-year follow-up (average, 50.1 months). Preoperative and latest follow-up, body mass index (BMI), Oswestry Disability Index, Scoliosis Research Society (SRS)-22 self-image and SRS outcomes scores were collected. Instrumented levels, estimated blood loss, major and minor complications, length of hospitalization, and hospital discharge status were also reviewed and compared. RESULTS A total of 66 patients were overweight (BMI > 25-29.9; average, 26.9) (Group OW), whereas 38 patients were obese (BMI > 30; average, 33.5) (Group OB). The average age was 54.5 in Group OW and 48.6 in Group OB (p < .01). Postoperatively, significant changes were not found in the BMI for Group OW, 27.2 (26.9-27.2; p < .39), and for Group OB, 35 (33.5-35; p < .06). Postoperatively, significant improvements were seen in both groups for Oswestry Disability Index (36.1-21.8, Group OW; 44.1-24.4, Group OB; p <.001), SRS self-image (2.9-3.7, Group OW; 2.6-3.8, Group OB; p < .001) and SRS score (3.1-3.8, Group OW; 2.9-3.8, Group OB; p < .001). There were no significant differences in complications between groups. CONCLUSIONS As a group, overweight and obese primary spinal deformity patients did not demonstrate significant weight gain or weight loss from preoperative to latest follow-up. However, both overweight and obese patients had significant improvements in outcome scores at latest follow-up and equivalent rates of complications.
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Affiliation(s)
- Addisu Mesfin
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA.
| | - Keith H Bridwell
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Jennifer M Jupitz
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Usman Akhtar
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Jeremy L Fogelson
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Stuart Hershman
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Linda A Koester
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
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Seo HJ, Kim HJ, Ro YJ, Yang HS. Non-neurologic complications following surgery for scoliosis. Korean J Anesthesiol 2013; 64:40-6. [PMID: 23372885 PMCID: PMC3558648 DOI: 10.4097/kjae.2013.64.1.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/02/2012] [Accepted: 05/14/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for scoliosis and to identify factors that can increase this risk. METHODS The demographic data, medical and surgical histories, and prevalence of non-neurologic complications were reviewed in a retrospective cohort of 602 patients, who had undergone corrective surgery for scoliosis between January 2001 and June 2011. RESULTS There were 450 patients under 20 years old (U20) and 152 of patients above 20 years old (A20) enrolled in this study. Forty-nine patients in U20 (10.9%) and 18 patients in A20 (11.8%) had post-operative complications. Respiratory complications were most common in U20 (4%) and gastrointestinal complications were most common in A20 (7%). There was no significant difference between the 2 groups in the prevalence of complications. Logistic regression revealed that factors that correlated with an increased odds for complications were Cobb angle (P = 0.001/P = 0.013, respectively), length of operation time (P = 0.003/P = 0.006, respectively), duration of anesthesia (P < 0.001/P = 0.005, respectively) and transfusion (P = 0.003/P = 0.015, respectively) in U20 and A20. Also, comorbidities (P = 0.021) in U20, and decreased body mass index (P = 0.030), pre-operative forced vital capacity (P = 0.001), forced expired volume in 1s (P = 0.001), increased numbers of vertebrae fused (P = 0.004), blood loss (P = 0.001) in A20 were associated with increased odds for complications. CONCLUSIONS There was no difference in the prevalence of complication in scoliosis patients by age. The prevalence of complication was dependent on Cobb angle, length of operation time, duration of anesthesia and transfusion of PRBC. Deterioration of preoperative pulmonary function significantly increased risk of post-operative complications in adult patients.
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Affiliation(s)
- Hye Jeong Seo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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