Diagnosis behind the mask: A rare case of infected Charcot's spine

Charcot's spine is a very uncommon long-term complication of spinal cord injury. Infection of the spine is a common pathology, but infection of a Charcot's spine is rare and is challenging to diagnose, especially in differentiating between the Charcot defect and the osteomyelitis defect. Surgical reconstruction has to be extremely individualized. A 65-year-old man with a history of thoracic spinal cord injury with paraplegia 49 years ago was admitted to our hospital with high fever and aphasia. After a thorough diagnostic process, destructive Charcot's spine and secondary infection were diagnosed. This report additionally reviews the surgical management of secondary infected destructive lumbar Charcot's spine and follows the patient's recovery and postoperative quality of life.

Spontaneous breathing for managing analgesia during balanced anesthesia with remifentanil and desflurane: a prospective, single center randomized controlled trial

The main goal of anesthesiology is to achieve the best level of analgesia and a fast recovery of consciousness following anesthesia. The preservation of spontaneous breathing during general anesthesia with anesthetic gases is practiced by many anesthetists. However, very few studies have dealt with these positive properties of volatile anesthetics such as sevoflurane or desflurane. Remifentanil is a very short half-life opiate that combines sufficient intra-operative analgesia with a fast post-operative recovery time. We tested the hypothesis that spontaneous breathing can reduce overdosing with remifentanil during desflurane anesthesia. In this prospective, single center, multiple anesthetist study, 30 patients were randomized into two groups (volume-controlled ventilation mode and spontaneous breathing). The spontaneous breathing group showed a significantly lower post-operative pain level than the volume-controlled ventilation mode group. Furthermore, less remifentanil as well as less piritramide was needed in the spontaneous breathing group compared with volume-controlled ventilation mode. It was possible to achieve spontaneous breathing in all patients with 0.6 minimum alveolar concentration desflurane, in order to control the remifentanil rate and prevent an overdose. All spontaneous breathing patients had low intra- and post-operative pain levels and the need for analgesics was equal to or lower than that in the volume-controlled ventilation mode group. By reducing the intra-operative amount of opiates, both the post-operative pain and the amount of post-operative analgesia required can be reduced. A balanced anesthesia with spontaneous intra-operative breathing is needed to determine the required amount of opiates. This study was approved by the Ethic Committee of the Ruhr-University of Bochum (approval No. 2435) in September, 2004.

Publication rate of abstracts presented at the Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT)

BACKGROUND

The publication rate of presented abstracts is an important parameter to assess the scientific quality of medical congresses. It has been investigated for many congresses in orthopaedics and traumatology, but until now, it has not been studied for the congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT). The aims of this study were to determine: (1) the publication rate of the EFORT congress, (2) factors that favour publication of abstracts presented at the EFORT congress, (3) the consistency between the congress abstract and publication in relation to authorship.

HYPOTHESIS

There are factors that favour publication of abstracts presented at the EFORT congress and there is a high consistency between the congress abstract and publication in relation to authorship.

MATERIALS AND METHODS

All 1624 abstracts presented at the EFORT congress in 2011 were included in this study, to allow a 5-year period for publication after the congress. The characteristics of the abstracts presented were studied and the publication rate in peer-reviewed journals was determined using a Medline search.

RESULTS

The publication rate for studies presented at the 2011 EFORT congress was 42% (677/1624 abstracts), with a mean of 16 months (-56 to 60 months) between congress and publication. The mean impact factor of the publications was 1.8 (0-7.6). A significantly higher publication rate was found for: oral presentations (52%; 322/617) versus posters (35%; 355/1007) (p<0.01), experimental studies (53%; 110/208) versus clinical studies (40%; 507/1254) (p<0.01), and studies with higher levels of evidence of I or II (59%; 144/244) versus studies with lower levels of evidence of III or IV (36%; 362/1005) (p<0.01). A new author was added in 59% (403/677) of the publications.

DISCUSSION

Factors that favour publication of abstracts presented at the EFORT congress are oral presentation, experimental study, and a study with a higher level of evidence of I or II. It is common that a new author is added in the publication. Nevertheless, a high percentage of congress abstracts (58%; 947/1624) remains unpublished.

LEVEL OF EVIDENCE

IV, retrospective study.

Rasterstereography versus radiography for assessing shoulder balance in idiopathic scoliosis: A validation study relative to patients' self-image

BACKGROUND

Shoulder imbalance is a problem for scoliosis patients. Rasterstereography uses radiation-free surface topography to follow up these patients. Its use for assessing shoulder level has not been investigated earlier.

OBJECTIVE

This study aimed to determine the accuracy of shoulder assessment using rasterstereography (versus radiography) and to analyze its relationship with patients' self-image.

METHODS

In a cross-sectional setting, the reliability and validity of five rasterstereographic shoulder variables were measured in comparison with six radiographic shoulder parameters, using correlation analysis. The patients' self-perception was documented using the Scoliosis Research Society-22 (SRS-22) questionnaire and Trunk Appearance Perception Scale (TAPS).

RESULTS

Forty patients were included in the study. The test-retest reliability of all rasterstereographic shoulder parameters was excellent (ICC > 0.95). The validity was moderate in comparison with six radiographic parameters (highest coefficient: 0.582). The radiographic and rasterstereographic shoulder levels correlated with the results in the SRS-22 questionnaire (highest coefficient: -0.463) and TAPS (highest coefficient: 0.413).

CONCLUSIONS

Rasterstereography is a reliable and valid method for assessing shoulder level in idiopathic scoliosis. The parameters can be recommended as a complement to radiography and clinical evaluation for follow-up purposes. Radiographic and rasterstereographic shoulder parameters are significantly related to patients' self-perception. Shoulder variables thus need to be considered in scoliosis patients.

Reliability and validity of the Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS)

Background

The Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS) are questionnaires that mostly rely on drawings to assess scoliosis patients’ subjective viewpoints on their trunk deformity. Our aim was to perform an in-depth assessment of the psychometric quality of both measures, the SAQ (version 1.1) and TAPS, and compare them to provide practical recommendations.

Methods

Web-based survey study with 255 patients suffering from idiopathic scoliosis (age 30.0 ± 16.7 years, Cobb angle 43.5 ± 20.9°) and 189 matched healthy control individuals. Participants answered a broad set of validated questionnaires including SRS 22-r, PHQ-9, PANAS, FKS, WHO-5, BFI-S, and PTQ. We calculated reliability (Cronbach’s α, test–retest correlations) as well as factorial, convergent, divergent, concurrent, and discriminant validity.

Results

Reliability was high (Cronbach’s α ≥ .86; test–retest r ≥ .80), except for test–retest correlation of the SAQ Expectations scale (r = 0.67). Both the SAQ and TAPS measures showed clear factor solutions, indicating factorial validity. High correlations with theoretically related measures (e.g., SRS 22-r, overall stress, Cobb angle) indicated convergent validity. Moderate correlations occurred with concurrent criteria such as mood, depression, body dysmorphic disorder, and well-being. The matched-pair analysis revealed strong evidence for discriminant validity (Cohen’s d > 2 for SAQ total score and TAPS). Subgroup analyses showed that patients with more severe Cobb angles (≥ 40°) and those ≥ 46 years of age had significantly worse SAQ and TAPS scores.

Conclusion

We recommend using the TAPS for future clinical workups and research, as it is much shorter and revealed slightly higher psychometric quality in comparison to the SAQ.

Electronic supplementary material

The online version of this article (10.1186/s13018-018-0980-1) contains supplementary material, which is available to authorized users.

German validation of the quality of life profile for spinal disorders (QLPSD)

BACKGROUND

The Quality of Life Profile for Spine Deformities (QLPSD) is a self-reporting questionnaire designed for studying patients with spinal deformities.

PURPOSE

The aim of the present study was to systematically translate the QLPSD into German (G-QLPSD) and to test its reliability and validity. Special emphasis was intended to be given to patients with different Cobb angles and ages.

METHODS

The QLPSD was systematically translated into German and was responded to in a web-based online survey by patients with idiopathic scoliosis and by healthy control individuals to carry out a matched-pair analysis. Participants aged 14 years and older were included. All participants answered a battery of validated questionnaires (SRS 22-r, PHQ-9, PANAS, FKS, WHO-5, BFI-S, PTQ). Reliability testing included Cronbach's alpha and test-retest reliability (retest 8 weeks after initial testing). Factorial, convergent, divergent, concurrent, and discriminant validity were calculated.

RESULTS

A total of 255 scoliosis patients (age 30.0 ± 16.7 years, Cobb angle 43.5° ± 20.9°) and 189 matched healthy control individuals were finally included. Cronbach's alpha for the G-QLPSD total score was 0.93 and the test-retest reliability was 0.84. The G-QLPSD total score correlated with the SRS 22-r total score (r = -0.86). All concurrently applied scores showed strong correlations with the G-QLPSD (e.g., depression score PHQ-9: r = 0.70). The matched-pair analysis of 189 pairs showed strong discriminant validity (Cohen's d = 0.78). Patients with more severe Cobb angles (≥40°) and those ≥18 years of age had significantly poorer results than patients with minor curves and younger patients.

CONCLUSION

The G-QLPSD proved to be a highly reliable and valid instrument that can be recommended for clinical use in scoliosis patients.

German validation of the BIDQ-S questionnaire on body image disturbance in idiopathic scoliosis

PURPOSE

The Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) is a seven-item questionnaire inquiring into patients' worries about back shape and associated problems at school, at work, with friends or family, and whether the patients are avoiding certain activities. The aim of this study was to translate the BIDQ-S into German (G-BIDQ-S), test its reliability, and establish its convergent, divergent, concurrent, and discriminant validity.

METHODS

In a prospective cohort study, 259 patients with idiopathic scoliosis (mean age 30.2; 221 female; mean Cobb angle 43.8°) completed the G-BIDQ-S; Scoliosis Research Society 22-r (SRS 22-r); Patient Health Questionnaire (PHQ-9); Positive and Negative Affect Schedule (PANAS); Questionnaire on Body Dysmorphic Symptoms (FKS); and WHO-5 Well-Being Index. Healthy control individuals matched by age, sex and BMI (n = 149; mean age 36.1; 133 female; BMI = 23.0) answered the same questions to establish discriminant validity. Discriminant statistics, and Pearson and Spearman correlations were calculated.

RESULTS

The G-BIDQ-S proved to be one-factorial, internally consistent (Cronbach alpha = 0.87), and stable over time (total score 2.22 vs. 2.21 during retest; retest reliability r = 0.79, P < 0.001). It correlated significantly with the mean SRS 22-r (r = -0.72, P < 0.001) and with Cobb angles (r = 0.30, P < 0.001)-convergent validity; much less with body mass index (r = 0.19, P < 0.001)-divergent validity; and with the PANAS (r = 0.55, P < 0.001), PHQ-9 (r = 0.53, P < 0.001), FKS (r = 0.67, P < 0.001), and WHO-5 (r = -0.54, P < 0.001)-concurrent validity. The G-BIDQ-S also showed discriminant validity, with a strong difference between the scoliosis group (total score 2.19) and the control group (total score 1.13; P < 0.001).

CONCLUSIONS

The G-BIDQ-S showed good internal consistency, reliability, and convergent, divergent, concurrent, and discriminant validity. This questionnaire is the first one inquiring into patients' body image disturbances that has been validated and is available in German.