Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation-A Quality Assessment.

Background: During the last few decades the prevalence of lumbar disc herniation has been increasing constantly, thereby imposing a significant socioeconomic burden. Physiotherapy plays a crucial role in both surgical and conservative treatment of lumbar disc herniation, consequently the current COVID-19 pandemic with concomitant lockdowns has led to a shortage of physiotherapeutical care. In the light of these recent events publicly available physiotherapy tutorials may be a useful tool to address this problem. Aim: The main aim of this study was to assess the quality of online physiotherapy exercise tutorials for lumbar disc herniation. Materials & Methods: With YouTube being a widely known and used platform we screened 240 of the most viewed videos. A total of 76 videos met the inclusion criteria and were statistically analyzed. The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Results: They displayed a wide range of views (44,969 to 5,448,717), likes (66 to 155,079) and dislikes (6 to 2339). The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Neither the number of "Views", "Likes", nor "Dislikes" was found to have a significant association with any of the quality measures used in this study. Conclusion: Overall quality grade was determined as "moderate". Based on the data examined in this study, the use of YouTube videos as a source of therapy advice for lumbar spine disc herniation cannot be recommended universally.

Long-term impact of sagittal malalignment on hardware after posterior fixation of the thoracolumbar spine: a retrospective study.

BACKGROUND: The importance of sagittal alignment in healthy individuals and in reconstructive spinal surgery has been studied over the last 15 years. The aim of the present study was to assess the long-term effects of abnormal sagittal alignment on hardware after posterior thoracolumbar spinal fusion. METHODS: Patients who had undergone revision surgery (revision cohort, n = 34) due to breakage of their implants were compared retrospectively with patients who had intact implants at the final follow-up investigation after a long posterior thoracolumbar and/or lumbar spinal fusion (control cohort, n = 22). Clinical data and radiological parameters including the sagittal vertical axis (SVA), pelvic incidence (PI), lordosis gap (LG), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and the femoral obliquity angle (FOA) were assessed on full-spine lateral radiographs obtained in regular standing position. Data were analysed using descriptive statistics, parametric and non-parametric inferential statistics. RESULTS: Patients in the breakage group (female n = 21, male n = 9, mean age 60.9 ± 15.6 years) had a higher anterior shift of the C7 plumb line (SVA) (p = 0.02), retroversion of the pelvis (PT) (p < 0.001), PI-LL mismatch (LG) (p = 0.001), and PI (p = 0.002) than the intact group (female n = 10, male n = 12, mean age 65.7 ± 12.4 years). No significant difference was registered between groups in regard of SS, LL, TK, FOA, and the mean number of comorbidities. CONCLUSION: Failure of restoration of the SVA and the LG to the acceptable ranges, especially in patients with a high PI, may be regarded as a risk factor for the long-term failure of implants after posterior thoracolumbar spinal fusion.

A prospective cohort study on the effectiveness of 3500 IU versus 5000 IU bemiparin in the prophylaxis of postoperative thrombotic events in obese patients undergoing orthopedic surgery.

BACKGROUND: Postoperative thromboses are among the most feared complications in orthopedic surgery as they may cause life-threatening conditions in otherwise highly successful procedures such as total joint replacement. Body weight is an important risk factor for thromboses and is used in algorithms to determine dosages in prophylaxis. However, weight patterns among orthopedic populations have changed considerably since the introduction of these algorithms, essentially shifting towards obesity. This study asks whether present-day obese patients would benefit from higher than usual dosages of bemiparin in the prophylaxis of postoperative thrombosis. PATIENTS AND METHODS: To detect at least a 5% difference in the incidence of clinically symptomatic thrombotic events with sufficient power, 750 patients were enrolled in the study and treated with 3,500 IU or 5,000 IU bemiparin. Differences in rates were modelled in a Poisson regression including as covariates the potential confounders severity of immobilization, sex, exact weight and age. RESULTS: Overall, 723 patients were followed for a total of 66.8 person-years and analyzed by intention-to-treat. The ratio of incidence rates in the two groups of patients was 0.35 (95% CI: 0.03-2.91), thus there was no evidence for a difference in rates between groups. There was, however, a borderline significant association between incidence rates and body weight. There were no complications resulting from the higher dosages of bemiparin. CONCLUSION: Both groups of treated patients showed low incidence rates of thromboses and we did not see a significant reduction of incidence rates with higher dosages of bemiparin in this population. However, there was weak evidence that higher dosages might prove beneficial if populations gain weight even further.

Does the placenta inhibit the passage of chromium and cobalt after metal-on-metal total hip arthroplasty?

Umbilical cord serum and corresponding maternal serum of 3 women with uncemented metal-on-metal total hip arthroplasties were analyzed for cobalt and chromium. The women were an average 3.8 (range, 2-5) years after hip surgery. At the time of delivery, the maternal chromium concentrations were 1.6 microg/l, 0.5 microg/l, and 0.9 microg/l, respectively, and the maternal cobalt concentration was 1 microg/l in the first woman and below the detection limit in the other 2 women. Cobalt and chromium concentrations of the 3 umbilical cord sera also were below the detection limit. This indicates that-with regard to the detection limit of our laboratory-we were unable to observe a passage of cobalt and chromium ions from metal-on-metal articulations across the placenta at the time of delivery.