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Wang Q, Hou G, Wen M, Ren Z, Duan W, Lei X, Yao Z, Zhao S, Ye B, Tu Z, Huang P, Xie F, Gao B, Hu X, Luo Z. How to assess the long-term recovery outcomes of patients with cauda equina syndrome before surgery: a retrospective cohort study. Int J Surg 2024; 110:01279778-990000000-01227. [PMID: 38502853 PMCID: PMC11254269 DOI: 10.1097/js9.0000000000001336] [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: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. We aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR. METHODS 356 patients with CES secondary to lumbar degenerative diseases treated at *** Hospital were randomly divided into training (N=238) and validation (N=118) cohorts at a 2:1 ratio. Moreover, 92 patients from the **** Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts. RESULTS After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9%, 44.1%, 63.7%, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cut-off value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor. CONCLUSION The first pre-treatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making.
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Affiliation(s)
- Qiushi Wang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
- Department of Orthopaedic, No. 970th Hospital of Joint Logistic Support Force of PLA, Yantai
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi’an
| | - Mengyuan Wen
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, People’s Republic of China
| | - Zhongwu Ren
- Department of Orthopaedic, No. 970th Hospital of Joint Logistic Support Force of PLA, Yantai
| | - Wei Duan
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Xin Lei
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhou Yao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Shixian Zhao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Bin Ye
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhipeng Tu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Peipei Huang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Fang Xie
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Bo Gao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Xueyu Hu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhuojing Luo
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
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Wu Y, Chen Z, Yao C, Sun H, Li H, Du X, Cheng J, Wan X. Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial. Sci Rep 2023; 13:17661. [PMID: 37848527 PMCID: PMC10582089 DOI: 10.1038/s41598-023-45022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
Surgery is one of the most frequent and effective intervention strategies for lumbar spinal stenosis, however, one-third of patients are not satisfied with postoperative outcomes. It is not clear whether perioperative systemic lidocaine could accelerate the early postoperative quality of recovery in patients undergoing lumbar spinal stenosis surgery. 66 patients were enrolled in this trial. Lidocaine or placebo was administered at a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour till the end of surgery. Continued infusion by postoperative patient-controlled intravenous analgesia with a dose of 40 mg/hour. The primary outcome was the quality of recovery. Secondary outcomes included the time of the patient's first flatus, catheter removal time, underground time from the end of the surgery, pain score, levels of inflammatory factors (IL-6, IL-10, TNF-α), postoperative nausea and vomiting (PONV), sufentanil rescues, patients' satisfaction scores, and complications of lidocaine. Eventually, 56 patients were in the final analysis with similar age, Body Mass Index (BMI), duration of surgery and anesthesia, and median QoR-15 score (a development and Psychometric Evaluation of a Postoperative Quality of Recovery Score). The difference in median QoR-15 score in placebo versus lidocaine patients was statistically significant (IQR, 106 (104-108) versus 114 (108.25-119.25), P < 0.001). The Numeric Rating Scale (NRS) score at the 12th hour, median sufentanil rescue consumption, IL-6, tumor necrosis factor-alpha (TNF-α) of patients treatment with lidocaine were lower. Nevertheless, patients given lidocaine had high satisfaction scores. Suggesting that lidocaine enhanced the postoperative quality of recovery, met early postoperative gastrointestinal function recovery, provided superior pain relief, lessened inflammatory cytokines, etc., indicating it may be a useful intervention to aid recovery following lumbar spinal stenosis surgery.
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Affiliation(s)
- Yu Wu
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Zhuoming Chen
- School of Textile and Fashion, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Caimiao Yao
- Department of Clinical Laboratory, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Houxin Sun
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Hongxia Li
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Xuyang Du
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Jianzheng Cheng
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China.
| | - Xiaojian Wan
- Department of Anesthesiology and Critical Care Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Kanematsu R, Hanakita J, Inoue T, Minami M, Suda I, Nakamura S, Ueno M, Takahashi T. Analysis of Neurogenic Bowel and Bladder Dysfunction Following Decompression Surgery for Cervical Spondylotic Myelopathy: A Prospective Cohort Study. Global Spine J 2023:21925682231202381. [PMID: 37707793 DOI: 10.1177/21925682231202381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVES To investigate preoperative prevalence of neurogenic bowel dysfunction and neurogenic bladder in patients with degenerative cervical myelopathy (DCM) and examine the degree and timing of symptom improvement after cervical decompression surgery. Factors contributing to symptom improvement were also analyzed. METHODS Among 75 patients with DCM who underwent cervical decompression, Constipation Scoring System (CSS) score, International Prostate Symptoms Score (IPSS), and Japanese Orthopaedic Association (JOA) score were assessed before surgery and 1, 3, 6, and 12 months after. Prevalence rates were calculated. Data regarding patient age, sex, disease status, disease duration, lesion level, and score changes was prospectively recorded and analyzed. RESULTS The prevalence rates of defecation and urinary dysfunction before surgery were 41.3% and 34.7%, respectively. Among the patients with defecation dysfunction, the number of patients who improved 1, 3, 6, and 12 months after surgery was 10, 9, 9, and 6, respectively. Among the patients with urinary dysfunction, the corresponding number of patients was 12, 10, 11, and 11, respectively. None of the factors we examined were significantly associated with improvement in either CSS or IPSS score; however, improvement of lower extremity JOA score tended to be associated with improvement in both. CONCLUSIONS The prevalence of symptoms of defecation and urinary dysfunction in patients with DCM was 41.3% and 34.7%, respectively. Decompression surgery improved symptoms in 20% to 46% of patients.
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Affiliation(s)
- Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Tomoo Inoue
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
- Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Manabu Minami
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Izumi Suda
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Sho Nakamura
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Manabu Ueno
- Department of Urology, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
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Zhang D, Tang H, Li T, Li P, Pan X, Jia Q, Wang L, Zhao Y. Application of rectal balloon ice water stimulation for the rehabilitation of stroke patients with neurogenic bowel dysfunction. NeuroRehabilitation 2023; 53:83-90. [PMID: 37424483 DOI: 10.3233/nre-230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Neurogenic bowel dysfunction (NBD) is a common complication in stroke patients. OBJECTIVE To investigate the effect of rectal balloon ice water stimulation on the rehabilitation of patients with NBD after a cerebral stroke. METHODS Forty stroke patients with NBD were selected between March and August 2022 and randomly divided into a study group (n = 20) and a control group (n = 20). Based on routine rehabilitation training, rectal balloon ice water stimulation or finger rectal stimulation were performed on the study or control group, respectively. After two weeks, the changes in the NBD, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores were compared between the two groups. RESULTS Before the intervention, there were no significant differences in age, sex ratio, and NBD, SDS and SAS scores between the two groups (p > 0.05). The NBD, SDS and SAS scores of both groups were significantly decreased following intervention (p < 0.05). After 2 weeks of intervention, the NBD score of the study group was significantly lower than that of the control group (5.50±1.28 vs 6.45±1.05; p = 0.014). The SDS score of the study group was lower than that of the control group, and the difference was statistically significant (32.30±2.81 vs 44.05±2.19; p = 0.014). The study group also had significantly lower SAS scores than the control group (p = 0.024). In addition, the incidence of dizziness, headaches, nausea, vomiting and abdominal pain and distension in the study group was significantly lower than in the control group (p < 0.05). CONCLUSION Rectal balloon ice water stimulation can significantly improve stroke patients with NBD's intestinal function and psychological status.
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Affiliation(s)
- Di Zhang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Hong Tang
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Ting Li
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Ping Li
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Xiangying Pan
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Qin Jia
- Department of Nursing, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, China
| | - Lu Wang
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Yanjun Zhao
- Jiangnan University Medical Center, Wuxi, China
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