Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity.

Introduction: The effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research question: To determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methods: In this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results: 1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P â€‹< â€‹0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P â€‹= â€‹0.016) and 1.182 times (P â€‹= â€‹0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P â€‹= â€‹0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p â€‹= â€‹0.016). Discussion and conclusions: Preoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery.

STUDY DESIGN: Retrospective cohort. PURPOSE: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. OVERVIEW OF LITERATURE: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. METHODS: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. RESULTS: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. CONCLUSIONS: The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.

Research Tendency in Lumbar Spinal Stenosis over the Past Decade: A Bibliometric Analysis.

OBJECTIVE: The purpose of this bibliometric analysis was to identify trends and hot topics in research on lumbar spinal stenosis (LSS) over the past decade, for helping researchers explore new directions for future research in that area. METHODS: All research articles on LSS, written in English and indexed in the Web of Science database (WoS) between 2010 and 2020, were used. The visualization of network and in-depth bibliometric analysis including the number of publications, countries, institutions, journals, authors, cited references, and key words was carried out with the help of CiteSpace. RESULTS: A total of 4033 papers (3577 original articles and 476 reviews) were identified and included in the study. The most productive year was in 2019. The Spine was the journal that published the highest number of articles and received the most citations. The most productive country and institutions in this field were the United States and Seoul National University, respectively. Kim HJ was the most prolific author, and Deyo RA ranked the first in the cited authors. The most cited article was published in 2010 by Deyo et al. and described the complications and charges index for LSS. From the coword cluster analysis, there were 3 frontiers in lumbar spinal stenosis: intervention, outcomes, and pathogenesis. CONCLUSIONS: We have summarized the literature on LSS in the past decade including publication information, country, institution, authors, and journal. Research on minimally invasive surgery, outcomes, and gene therapies in LSS will be hot topics in the future.

Management and results of early-onset scoliosis with dual magnetically controlled growing rods: Additional preliminary results of spinal fusion surgery.

OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic outcomes and complications of dual magnetically controlled growing rods (MCGRs) in the treatment of early-onset scoliosis (EOS) and to investigate the results of patients with definitive spinal fusion following MCGR. PATIENTS AND METHODS: A total of 15 patients (7 males, 8 females; mean age: 8.7±1.7 years; range, 6 to 10 years) with EOS who underwent dual MCGR and were prospectively followed between February 2013 and March 2019 were included in this retrospective study. The Cobb angle, thoracic kyphosis, and the length of the spine between T1-T12 and T1-S1 were measured on preoperative, postoperative, and follow-up radiographs. The 24-Item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to assess the functional outcomes before and after the operation. All complications during the treatment were recorded. RESULTS: The mean follow-up was 27.8±10.4 (range, 12 to 60) months. The mean curve correction immediately after the index surgery and latest follow-up was 47.6% and 42.4%, respectively (p>0.05). At the last follow-up, there were no significant changes in mean Cobb and kyphosis angles. The mean T1-T12 length increase was 26.2±7.1 (range, 16 to 40) mm, while the mean T1-S1 length increase was 43.3±15.0 (range, 24 to 70) mm. Complications developed in four (26.6%) of 15 patients. Definitive spinal fusion surgery was performed in seven patients. Total mean Cobb angle difference between the final follow-up and fusion surgery was 9.3° (p=0.016) and kyphosis angle difference was -2.1° (p=0.349). After fusion surgery, total lengthening in T1-T12 and T1-S1 distance was 10.5 mm (p=0.036) and 15.0 mm (p=0.022), respectively. A significant increase in all subdomain scores of the EOSQ-24 (p<0.05), except for financial impact, was recorded in all patients. CONCLUSION: Dual MCGR technique is an effective, reliable, and robust treatment alternative for primary EOS. However, surgeons should be aware of the relatively high rate of complications. In addition, residual deformity can be corrected successfully with definitive surgery.

Accuracy of Freehand Versus Modified Funnel Technique for Pedicle Screw Insertion in the Thoracic Spine.

AIM: To describe a new pedicle screw insertion technique, a modification of the funnel technique, and to compare this technique with conventional freehand screw insertion regarding their accuracy and complications in the thoracic spine. MATERIAL AND METHODS: Three hundred forty-three patients who underwent a posterior spinal fusion with different etiologies were retrospectively analyzed. In 84 patients, pedicle screws were placed using the freehand technique, and in 259 patients, the modified funnel technique was used. Screw malposition was evaluated in the immediate and final follow-up in anteroposterior and lateral spinal radiographs by two independent observers. The rates of incorrect pedicle screws and complications, surgical duration, and estimated blood loss were compared between the groups. RESULTS: A total of 6141 pedicle screws (1468 in the freehand group, 4673 in the modified funnel group) were evaluated. The rate of incorrect pedicle screws was higher in the freehand group (12.0% vs. 4.6%, p=0.001). The surgical time was shorter in the modified funnel group (190.9 ± 57.0 vs. 174.1 ± 47.6 min; p=0.017). The estimated blood loss was similar between the groups (1391.50 ± 570.01 vs. 1264.13 ± 602.29 mL; p=0.053). There were 82 intraoperative pedicle fractures but no neurologic complications in either group. CONCLUSION: The modified funnel technique provides more accurate pedicle screw insertion in the thoracic spine in the presence of dysplastic pedicles in conjunction with axial rotation compared with the freehand technique. Furthermore, surgical time may be reduced without increasing blood loss.

Variation of Minimum Clinically Important Difference by Age, Gender, Baseline Disability, and Change of Direction in Adult Spinal Deformity Population: Is It a Constant Value?

BACKGROUND: The minimum clinically important difference (MCID), an important concept to evaluate the effectiveness of treatments, might not be a single "magical" constant for any given health-related quality of life (HRQoL) scale. Thus, we analyzed the effects of various factors on MCIDs for several HRQoL measures in an adult spinal deformity population. METHODS: Surgical and nonsurgical patients from a multicenter adult spinal deformity database who had completed pretreatment and 1-year follow-up questionnaires (Core Outcome Measures Index [COMI], Oswestry Disability Index [ODI], Medical Outcomes Study 36-item short-form questionnaire, 22-item Scoliosis Research Society Outcomes questionnaire, and an anchor question of "back health"-related change during the previous year) were evaluated. The MCIDs for each HRQoL measure were calculated using an anchor-based method and latent class analysis for the overall population and subpopulations stratified by age, gender, and baseline scores (ODI and COMI) separately for patients with positive versus negative perceptions of change. RESULTS: Patients with a baseline ODI score of <20, 20-40, and >40 had an MCID of 2.24, 11.35, and 26.57, respectively. Similarly, patients with a baseline COMI score of <2.75, 2.8-5.4, and >5.4 had an MCID of 0.59, 1.38, and 3.67 respectively. The overall MCID thresholds for deterioration and improvement were 0.27 and 2.62 for COMI, 2.23 and 14.31 for ODI, and 0.01 and 0.71 for 22-item Scoliosis Research Society Outcomes questionnaire, respectively. CONCLUSIONS: The results from the present study have demonstrated that MCIDs change in accordance with the baseline scores and direction of change but not by age or gender. The MCID, in its current state, should be considered a concept rather than a constant.

Anterior Spinal Artery Syndrome: Rare Precedented Reason of Postoperative Plegia After Spinal Deformity Surgery: Report of 2 Cases.

BACKGROUND: Complications in spinal deformity surgery vary from insignificant to severe. Apart from direct mechanical insult, ischemia can also cause spinal cord injury. Ischemic injury may be detected during surgery or may manifest itself postoperatively. We present 2 cases of anterior spinal artery syndrome. CASE DESCRIPTION: In the first case, a 12-year-old girl developed anterior spinal artery syndrome resulting in total quadriplegia 8 hours after spinal deformity surgery. She was treated with a steroid, immunoglobulin, and low-molecular-weight heparin. She showed complete recovery at 1 year postoperatively both clinically and radiographically. In the second case, a 62-year-old woman experienced sudden loss of motor evoked potentials intraoperatively during dural tear repair after sagittal and coronal alignment was established. The paraplegic patient was diagnosed with anterior spinal artery syndrome at the thoracic level postoperatively. She was treated with a steroid and heparin. At 1 year postoperatively, she has gained much of her strength and has myelomalacia in her spinal cord. CONCLUSIONS: Anterior spinal artery syndrome is a serious condition with a generally poor prognosis. Though treatment should be directed at the underlying cause, the best strategy is to prevent it from occurring. Peroperative blood pressure control, intraoperative neuromonitoring, avoidance from mechanical stress during surgery, and close neurologic and hemodynamic monitorization postoperatively should be performed.

Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference.

BACKGROUND: Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS: From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 ± 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS: Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS: Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.