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Mathkour M, Shapiro SZ, Scullen T, Werner C, Kilgore MD, Chavarro VS, Denis DR. Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage. Medicina (B Aires) 2022; 58:medicina58091172. [PMID: 36143849 PMCID: PMC9502586 DOI: 10.3390/medicina58091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. Methods: Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). Results: Surgical indications were sagittal plane imbalance caused by L4–L5 degenerative spondylolisthesis (n = 2) and L3–L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2–4) and estimated blood loss was 266 mL (range 200–300). NRS and ODI improved in all patients. All experienced improvements in LL (x¯preop = 33°, x¯postop = 56°), SVA (x¯preop = 180 mm, x¯postop = 61 mm) and PI-LL (x¯preop = 26°, x¯postop = 5°). Conclusion: ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients.
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Affiliation(s)
- Mansour Mathkour
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Stephen Z. Shapiro
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Tyler Scullen
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Cassidy Werner
- Department of Neurosurgery, Northwell Health, Manhasset, NY 11030, USA
| | - Mitchell D. Kilgore
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Velina S. Chavarro
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
| | - Daniel R. Denis
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
- Correspondence: ; Tel.: +1-(310)-606-1403
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Chavarro VS, Mealy MA, Simpson A, Lacheta A, Pache F, Ruprecht K, Gold SM, Paul F, Brandt AU, Levy M. Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder. Neurol Neuroimmunol Neuroinflamm 2016; 3:e286. [PMID: 27800532 PMCID: PMC5079380 DOI: 10.1212/nxi.0000000000000286] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/01/2016] [Indexed: 12/17/2022]
Abstract
Objective: To investigate depression frequency, severity, current treatment, and interactions with somatic symptoms among patients with neuromyelitis optica spectrum disorder (NMOSD). Methods: In this dual-center observational study, we included 71 patients diagnosed with NMOSD according to the International Panel for NMO Diagnosis 2015 criteria. The Beck Depression Inventory (BDI) was classified into severe, moderate, or minimal/no depressive state category. We used the Fatigue Severity Scale to evaluate fatigue. Scores from the Brief Pain Inventory and the PainDETECT Questionnaire were normalized to estimate neuropathic pain. Psychotropic, pain, and immunosuppressant medications were tabulated by established classes. Results: Twenty-eight percent of patients with NMOSD (n = 20) had BDI scores indicative of moderate or severe depression; 48% of patients (n = 34) endorsed significant levels of neuropathic pain. Severity of depression was moderately associated with neuropathic pain (r = 0.341, p < 0.004) but this relationship was confounded by levels of fatigue. Furthermore, only 40% of patients with moderate or severe depressive symptoms received antidepressant medical treatment. Fifty percent of those treated reported persistent moderate to severe depressive symptoms under treatment. Conclusions: Moderate and severe depression in patients with NMOSD is associated with neuropathic pain and fatigue and is insufficiently treated. These results are consistent across 2 research centers and continents. Future research needs to address how depression can be effectively managed and treated in NMOSD.
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Affiliation(s)
- Velina S Chavarro
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Maureen A Mealy
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Alexandra Simpson
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Anna Lacheta
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Florence Pache
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Klemens Ruprecht
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stefan M Gold
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Alexander Ulrich Brandt
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Levy
- NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany
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