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Yuan Y, Wang SK, Chai XY, Wang P, Li XY, Kong C, Lu SB. The implementation of enhanced recovery after surgery pathway in patients undergoing posterior thoracolumbar fusion for degenerative spinal deformity. BMC Musculoskelet Disord 2023; 24:29. [PMID: 36639811 PMCID: PMC9837952 DOI: 10.1186/s12891-023-06146-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The prevalence of degenerative spinal deformity (DSD) and the increased cost of correction surgery impose substantial burdens on the health care and insurance system. The aim of our study was to investigate the effects of the implementation of Enhanced Recovery After Surgery (ERAS) protocol on postoperative outcomes after complex spinal surgery. METHODS A retrospective analysis of prospectively established database of DSD was performed. The consecutive patients who underwent open correction surgery for degenerative spinal deformity between August 2016 and February 2022 were reviewed. We extracted demographic data, preoperative radiographic parameters, and surgery-related variables. The ERAS patients were 1:1 propensity-score matched to a historical cohort by the same surgical team based on age, gender, BMI, and number of levels fused. We then compared the length of hospital stay (LOS), physiological functional recovery, and the rates of complications and readmissions within 90 days after surgery between the groups. RESULTS There were 108 patients included, 54 patients in the ERAS cohort, and 54 patients matched control patients in the historical cohort. The historical and ERAS cohorts were not significantly different regarding demographic characteristics, comorbidities, preoperative parameters, operative time, and reoperation rate (P > 0.05). Patients in the ERAS group had significantly shorter postoperative LOS (12.0 days vs. 15.1 days, P = 0.001), average days of drain and urinary catheters placement (3.5 days vs. 4.4 days and 1.9 days vs 4.8 days, respectively), and lower 90-day readmission rate (1.8% vs. 12.9%, P = 0.027). The first day of assisted-walking and bowel movement occurred on average 1.9 days (2.5 days vs. 4.4 days, P = 0.001) and 1.7 days (1.9 days vs. 3.6 days, P = 0.001) earlier respectively in the ERAS group. Moreover, the rate of postoperative urinary retention (3.7% vs. 16.7%, P = 0.026) and surgical site infection (0% vs. 7.4%, P = 0.046) were significantly lower with ERAS protocol applied. CONCLUSIONS Our study confirmed that the ERAS protocol was safe and essential for patients undergoing thoracolumbar deformity surgery for DSD. The ERAS protocol was associated with a shorter postoperative LOS, a lower rate of 90-day readmission, less rehabilitation discharge, and less postoperative complications.
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Affiliation(s)
- Yi Yuan
- Department of Orthopedics, No.6 Hospital, Beijing, 100007 China
| | - Shuai-Kang Wang
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Xin-Yi Chai
- grid.24696.3f0000 0004 0369 153XCapital Medical University, Beijing, 10053 China
| | - Peng Wang
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Xiang-Yu Li
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Chao Kong
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
| | - Shi-Bao Lu
- grid.413259.80000 0004 0632 3337Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 10053 China
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Yang S, Chen C, Du S, Tang Y, Li K, Yu X, Tan J, Zhang C, Rong Z, Xu J, Wu W, Luo F. Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity. BMC Musculoskelet Disord 2020; 21:827. [PMID: 33298028 PMCID: PMC7724710 DOI: 10.1186/s12891-020-03844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Background A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL. Methods In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed. Results When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05). Conclusions We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.
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Affiliation(s)
- Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 83nd Group Army Hospital of the People's Liberation Army (PLA 371 Central Hospital), Xinxiang Medical College, 210 Wenhua Street, Hongqi district, Xinxiang, 453000, Henan, China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Shiyu Du
- War Wounded Medical Service Research Office (Department of War Injury and Rescue Service), Army Specialty Medical Center of the People's Liberation Army (Daping Hospital, Third Military Medical University), Chongqing, 400042, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 72nd Group Army Hospital of the People's Liberation Army, Huzhou University, Huzhou, 313000, Zhejiang, China
| | - Kai Li
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Zhigang Rong
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.
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Fu J, Yao ZM, Wang Z, Cui G, Ni M, Li X, Chen JY. Surgical treatment of osteoporotic degenerative spinal deformity with expandable pedicle screw fixation: 2-year follow-up clinical study. Orthop Traumatol Surg Res 2018; 104:411-415. [PMID: 29248763 DOI: 10.1016/j.otsr.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/20/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoporotic bone offers poor purchase for the instrumentation in patients with degenerative spinal deformity (DSD), which could lead to several complications. Recently, augmentation methods to improve pedicle screw fixation have been proposed. This retrospective study was to investigate the clinical and radiographic outcomes of expandable pedicle screws (EPS) in patients with osteoporotic DSD. HYPOTHESIS Expandable pedicle screws (EPS) provide excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes. MATERIALS AND METHODS A total of 27 (6 males and 21 females) DSD patients who underwent orthopedics operation with EPS were retrospectively studied. Full-length standing spinal radiographs were obtained in all patients pre- and postoperatively and again at the two-year follow-up. The functional evaluations before operation and at two-year follow-up were graded with Scoliosis Research Society outcomes instrument-22 (SRS-22) and Oswestry Disability Index (ODI) scoring system. RESULTS All patients obtained good corrective outcomes on spinal deformity. The preoperative ODI score was 36.7% and reduced to 11.9% at two-year follow-up (p=0.0000). Before operation, the SRS-22 function, pain, appearance and mental scores were 2.7±0.4, 3±0.6, 2.7±0.5 and 2.9±0.6, respectively. The scores at two-year follow-up were significantly improved to 3.8±0.7, 4.2±0.6, 4.3±0.6 and 4.4±0.7, respectively (p=0.0000). The SRS-22 satisfaction score was 4.6±0.4 at two-year follow-up. No instances of screw breakage, loosening or pullout in any patient at follow-up. DISCUSSION EPS provides excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes at two years' follow-up. TYPE OF STUDY Retrospective case series study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China
| | - Z M Yao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, PR China
| | - Z Wang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China
| | - G Cui
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China
| | - M Ni
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China
| | - X Li
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China
| | - J Y Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28, Fuxing Road, 100853 Beijing, PR China.
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