RESUMEN
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). SETTINGS: Multi-institutions in Japan. METHODS: We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. RESULTS: Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). CONCLUSIONS: Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. SPONSORSHIP: No funding was received for this study.
Asunto(s)
Traumatismos de la Médula Espinal , Humanos , Persona de Mediana Edad , Anciano , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/terapia , Estudios Retrospectivos , Actividades Cotidianas , Recuperación de la Función , Albúmina SéricaRESUMEN
BACKGROUND: To investigate and compare the surgical outcomes of short and thoracopelvic corrective fusion with our two-stage technique using lateral lumbar interbody fusion (LLIF) and posterior open surgery. METHODS: Consecutive patients with adult spinal deformities who underwent a planned two-stage anterior-posterior surgery, using LLIF for the first stage and posterior open corrective fusion for the second stage, with a minimum of 2 years of follow-up were included. Patients who underwent lumbar or lumbosacral corrective fusion and thoracopelvic corrective fusion were categorized into the short group and thoracopelvic groups, respectively. We investigated the spinopelvic parameters and patient-reported outcome measurements. RESULTS: Seventy-four consecutive patients (8 men, 66 women; average age, 70.0 years) were included. Ten patients underwent short corrective fusion following significant improvements in the symptoms and radiographic parameters post-LLIF. Several preoperative spinopelvic parameters were better in the short group. Compared to the thoracopelvic group, those who underwent short fusion had a poorer alignment 2 years postoperatively but with comparable results and a significantly higher function score on the Scoliosis Research Society-22 r (SRS-22r) questionnaire. The mean Oswestry Disability Index and SRS-22r scores significantly improved during the 2-year postoperative follow-up in both the groups. CONCLUSIONS: Short corrective fusion can be considered in patients whose symptoms and radiographic parameters significantly improve following LLIF. Patients who undergo short fusion with LLIF application have poorer alignment than those who undergo thoracopelvic fusion 2 years postoperatively; however, the results are comparable, and the function score is significantly improved.
Asunto(s)
Escoliosis , Fusión Vertebral , Adulto , Masculino , Humanos , Femenino , Anciano , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/etiología , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Escoliosis/etiología , Fusión Vertebral/métodos , Región Lumbosacra/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Cross-sectional studies on diffuse idiopathic skeletal hyperostosis have focused on its incidence and related factors. However, the long-term changes caused by the disease remain unclear. This longitudinal cohort study aimed to elucidate the progression of diffuse idiopathic skeletal hyperostosis and its effects on physical function, health-related quality of life, and spinal alignment. METHODS: We recruited 255 older adults (87 men and 168 women; average age, 71.3 years in 2014) who attended local health checkups in 2014 and 2020. Height, body weight, body mass index, blood pressure, grip strength, functional reach, and bone mineral density were measured. The prevalence, location, number of ossified contiguous vertebrae, and spinopelvic parameters were estimated using whole-spine standing radiographs. For health-related quality of life assessment, the Oswestry disability index and EuroQuol-5D were obtained. We performed a 1:1 case-control study with age and sex-matched patients with and without diffuse idiopathic skeletal hyperostosis and analyzed progression over a 6-year period. RESULTS: In 2014, 39 (15.3%) of 255 patients were diagnosed with diffuse idiopathic skeletal hyperostosis (24 males and 15 females), which occurred more frequently in the elderly and males. In 2020, 12 (4.3%) patients were newly diagnosed with diffuse idiopathic skeletal hyperostosis, and 28 (71.7%) of 39 patients diagnosed in 2014 showed varying degrees of progression. Compared with age- and sex-matched patients without diffuse idiopathic skeletal hyperostosis, patients with the condition had higher body mass index and lumbar bone mineral density, larger sagittal vertical axis, and greater T1-pelvic angle. Changes in physical function and spinal-pelvic parameters during the 6-year period did not differ between the groups. CONCLUSIONS: Over a 6-year period, the prevalence of diffuse idiopathic skeletal hyperostosis increased by 4.3%, and it progressed in 71.7% of patients. However, it had little effect on longitudinal physical function, health-related quality of life, and spinopelvic parameters in older adults.
Asunto(s)
Hiperostosis Esquelética Difusa Idiopática , Masculino , Humanos , Femenino , Anciano , Estudios Longitudinales , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/epidemiología , Estudios Transversales , Estudios de Casos y Controles , Calidad de VidaRESUMEN
BACKGROUND: This study aimed to determine the impact of the multi-rod construct on rod fractures over a minimum follow-up period of five years in comparison to that with the conventional two-rod construct using the same technique, rod composition, and rod reinforcement method. METHODS: Data were retrospectively retrieved from a prospectively collected, single-center database. Consecutive patients >50 years of age who underwent thoracopelvic corrective fusion with planned two-stage anterior-posterior surgery and were followed up for at least five years were included in this study. The incidence of rod fracture in the conventional two-rod and multi-rod groups was investigated. RESULTS: A total of 58 patients (mean age, 68.9 years) were included in this study (follow-up rate, 73.4 %). Rod fracture was identified in 25 patients (43.1 %), within an average period of 25.1 months. The incidence of rod fracture in the multi-rod group was significantly lower than that in the two-rod group. However, there was no significant difference in the time to rod fracture between the two groups. Reinforcement of the multi-rod to the distal portion of the connector of the iliac screw had the lowest fracture rate and no cases of reoperation. CONCLUSIONS: The incidence of rod fracture was significantly lower using multi-rod reinforcement, but the timing of rod fracture did not differ, compared to that with the two-rod construct using the same surgical technique and rod material. Multi-rod reinforcement covering the distal portion of the iliac screw is recommended to reduce the risk of fracture and reoperation.
RESUMEN
BACKGROUND: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. METHODS: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. RESULTS: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. CONCLUSIONS: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.
Asunto(s)
Médula Cervical , Traumatismos de los Tejidos Blandos , Traumatismos de la Médula Espinal , Anciano , Humanos , Resultado del Tratamiento , Médula Cervical/lesiones , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Estudios Retrospectivos , Vértebras Cervicales/cirugía , Vértebras Cervicales/lesiones , Estudios Multicéntricos como AsuntoRESUMEN
PURPOSE: Frailty is caused by age-related decline in physical function, which may contribute to worsening spinal alignment. Cardiovascular Health Study (CHS)-criteria for assessing physical function seem more appropriate than frailty index which evaluate comorbiduty. However, there have been no reports investigating the relationship between frailty and spinal alignment using the CHS criteria. This study aimed to examine spinal radiographic parameters using the CHS criteria in volunteers participating in a health screening study. METHODS: The subjects were 211 volunteers (71 males and 140 females) aged 60-89 years old who participated in the TOEI study in 2018 and 2020. They were divided into three groups (R: robust, PF: pre-frailty, and F: frailty) according to the score of the Japanese version of the CHS (J-CHS) criteria in 2018. The radiographic parameters were evaluated using a whole-spine standing X-ray. RESULTS: There were 67 volunteers in group R, 124 volunteers in group PF, and 20 volunteers in group F. Of the five items in the J-CHS criteria, low activity was the most common in the PF group (64%). Low activity was also the most common in the F group (100%). Regarding spinal alignment, significant differences were found in C7SVA in 2020 (R:PF:F = 26:31:62 mm, P = 0.047), C2SVA in 2018 (20:34:63 mm, P = 0.019), and C2SVA in 2020 (37:47:78 mm, P = 0.041). CONCLUSION: Frailty was associated with a worsening in global alignment along the 2- year follow up. The frailty may begin with a decrease in activity and progression of exhaustion; preventing this progression is important through motivation to exercise. LEVEL OF EVIDENCE: II.
Asunto(s)
Fragilidad , Anciano , Masculino , Femenino , Humanos , Persona de Mediana Edad , Anciano de 80 o más Años , Fragilidad/diagnóstico por imagen , Fragilidad/epidemiología , Anciano Frágil , Estudios Longitudinales , Evaluación GeriátricaRESUMEN
PURPOSE: This study aimed to compare the clinical features and postoperative outcomes in patients with Lenke type 5C AIS in the early and late teens. METHODS: The study included eligible patients with AIS aged < 20 years with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion. The patients were divided into two groups according to the age: younger (11-15 years) and older (16-19 years). Demographic data, radiographic parameters, and 22-item scoliosis research society questionnaire (revised) (SRS-22r) scores were compared. RESULTS: Seventy-three (female: 69, male: 4, mean age: 15.1 years) patients were included. There were 45 and 28 patients in the younger and older groups, respectively. The older group exhibited a significantly smaller TL/L curve than the younger group, whereas no between-group differences were identified regarding curve flexibility and fusion length. The change in coronal balance and subjacent disc angle from preoperative to 2 years after surgery was significantly greater in the younger group, although each curve was equally corrected. Preoperative SRS-22r scores in the older group were significantly worse; however, they improved to the level of the younger group at 2 years after surgery. Postoperative coronal malalignment was observed in six patients (21.4%) in the older group, whereas no cases in the younger group (p < 0.05). CONCLUSION: In patients with Lenke type 5C AIS, we showed that late teens had significantly worse SRS-22r scores than did early teens. Postoperative coronal malalignment was frequently observed in the late teens due to the reduced ability of compensation by subjacent disc wedging.
Asunto(s)
Cifosis , Escoliosis , Fusión Vertebral , Humanos , Masculino , Adolescente , Femenino , Niño , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the impact of early post-injury respiratory dysfunction for neurological and ambulatory ability recovery in patients with cervical spinal cord injury (SCI) and/or fractures. METHODS: We included 1,353 elderly patients with SCI and/or fractures from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were included in the respiratory dysfunction group, which was further classified into mild and severe respiratory groups based on respiratory weaning management. Patient characteristics, laboratory data, neurological impairment scale scores, complications at injury, and surgical treatment were evaluated. We performed a propensity score-matched analysis to compare neurological outcomes and mobility between groups. RESULTS: Overall, 104 patients (7.8%) had impaired respiratory function. In propensity score-matched analysis, the respiratory dysfunction group had a lower home discharge and ambulation rates (p = 0.018, p = 0.001, respectively), and higher rate of severe paralysis (p < 0.001) at discharge. At the final follow-up, the respiratory dysfunction group had a lower ambulation rate (p = 0.004) and higher rate of severe paralysis (p < 0.001). Twenty-six patients with severe disability required respiratory management for up to 6 months post-injury and died of respiratory complications. The mild and severe respiratory dysfunction groups had a high percentage of severe paraplegic cases with low ambulatory ability; there was no significant difference between them. The severe respiratory dysfunction group tended to have a poorer prognosis. CONCLUSION: Respiratory dysfunction in elderly patients with SCI and/or cervical fracture in the early post-injury period reflects the severity of the condition and may be a useful prognostic predictor.
Asunto(s)
Médula Cervical , Traumatismos del Cuello , Traumatismos de la Médula Espinal , Fracturas de la Columna Vertebral , Humanos , Anciano , Pronóstico , Médula Cervical/lesiones , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/cirugía , Fracturas de la Columna Vertebral/cirugía , Parálisis , Traumatismos del Cuello/complicaciones , Vértebras Cervicales/cirugíaRESUMEN
BACKGROUND: Cerebrospinal fluid (CSF) leakage occurs in patients who undergo dural repair using artificial dura mater. This study aimed to determine if perioperative lumbar subarachnoid drainage could reduce the incidence of postoperative CSF leakage in cases of dural repair using artificial dura mater. METHODS: We retrospectively analyzed 84 patients (41 men, 43 women; mean age, 52.2 ± 20.1 years) who underwent intradural spinal cord tumor resection and dural repair using artificial dura mater. These patients were divided according to whether they underwent perioperative lumbar subarachnoid drainage (39 patients: D group) or had no drainage (45 patients: ND group). The incidence of radiographic and symptomatic CSF leakage as well as baseline characteristics and operative data were compared between the two groups. RESULTS: Radiographic CSF leakage was observed in 21 patients (25.0%), including 10 (25.6%) in the D group and 11 (24.4%) in the ND group. Symptomatic CSF leakage was observed in 12 patients (14.2%), including six (15,4%) in the D group and 11 (13.3%) in the ND group. There were no significant differences in the incidence of subcutaneous CSF accumulation and symptomatic CSF leakage between the two groups. In cases with symptomatic CSF leakage, the onset time of CSF leakage tended to be earlier (5.7 days vs 15.7 days), and the treatment period tended to be longer (5.8 weeks vs 2.8 weeks) in the ND group than in the D group. CONCLUSIONS: Perioperative lumbar subarachnoid drainage did not reduce the incidence of either radiographic or symptomatic CSF leakage. However, it might shorten the treatment period and reduce refractory CSF leakage, which requires multiple treatments over a long period.
Asunto(s)
Pérdida de Líquido Cefalorraquídeo , Neoplasias de la Médula Espinal , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/prevención & control , Procedimientos Neuroquirúrgicos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugía , Duramadre/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: The incidence of rod fracture after corrective surgery for adult spinal deformity (ASD) is high. Although many reports have investigated the effects of rod bending considering postoperative body motion, and countermeasures, there are no reports investigating the effects during intraoperative correction. The purpose of this study was to investigate the effect of ASD correction on rods by using finite element analysis (FEA) based on the rod shape changes before and after spinal corrective fusion. METHODS: Five ASD patients (mean age 73 years, all female) who underwent thoracic to pelvic fusion were included in this study. A 3D rod model was created using computer-aided design software from digital images of the intraoperatively bended rod and intraoperative X-ray images after corrective fusion. The 3D model of the bent rod was meshed by dividing each of the screw head intervals into 20 sections and cross-section of the rod into 48 sections. Two surgical fusion methods of stepwise fixation as the cantilever method and parallel fixation as the translational method were simulated to evaluate stress and bending moments on the rods during intraoperative correction. RESULTS: The stresses on the rods were 1500, 970, 930, 744, and 606 MPa in the five cases for stepwise fixation and 990, 660, 490, 508, and 437 MPa for parallel fixation, respectively, with parallel fixation having lower stresses in all cases. In all cases, maximum stress was found around the apex of the lumbar lordosis and near L5/S1. The bending moment was high around L2-4 in most cases. CONCLUSIONS: The external forces of intraoperative correction had the greatest effect on the lower lumbar region, especially around the apex of the lumbar lordosis.
RESUMEN
BACKGROUND: Improvements in spinal fusion devices and techniques have enabled stronger spinal fusion, resulting in excellent clinical outcomes. Nevertheless, complications associated with implants, such as screw misalignment, screw lubrication, cage dislocation, and skin issues, might occur. This study aimed to investigate the characteristics and symptoms of sacral fractures after spinal instrumented fusion. METHODS: This case series retrospectively examined the medical records of eight patients (one man and seven women; mean age: 74 years) diagnosed with sacral fractures after undergoing posterior spinal instrumented fusion from February 2015 to March 2022. RESULTS: The average number of fusion levels in all patients was 3.5 (range, 1-10). The lowest instrumented vertebrae (LIV) ranged from L5 to the ilium. Sacral fractures were diagnosed at 18.8 (range, 0.5-84) months postoperatively. The average time from consultation to diagnosis was nine days (range, 0-25 days). Two patients had subclinical fractures, two had H-shaped fractures with the LIV at L5, and four had U-shaped fractures, including screw holes. Buttock pain and lower extremity pain, the most commonly reported symptoms, were observed in seven patients each. There were also instances of leg numbness, muscle weakness, and unilateral leg pain that may be related to L5 or S1 radiculopathy. In all patients, leg and buttock pain were worse during movement and in the sitting position, and better while resting and in the supine position. Three patients were treated conservatively, and five were treated with extended fixation to the ilium. CONCLUSIONS: Sacral fractures following posterior spinal fusion can cause radiculopathy and buttock pain. Symptoms are especially severe when instability occurs in the pelvic region, such as during movements or sitting. As atypical radiculopathy may lead to delays in diagnosis, spine surgeons should recognize the symptoms of this condition.
RESUMEN
BACKGROUND: This study aimed to clarify sex differences in the relationship between trunk muscle mass, aging, and whole-body sagittal alignment. METHODS: Subjects aged 60-89 years who underwent musculoskeletal screening in 2018 were included in the study. Subject demographics, trunk muscle mass (TMM) measured by bioelectrical impedance analysis (BIA), and spinopelvic and lower extremity alignment parameters measured from standing radiographic images were investigated. Additionally, TMM was corrected for BMI (TMM/BMI). The relationship between trunk muscle and whole-body sagittal alignment was analyzed for each age group (young-old group (60-74 years) and old-old group (>75 years)) and sex. RESULTS: A total of 281 (mean age 75.4 ± 6.7 years, 100 males and 181 females) were enrolled. The trunk muscle mass in both men and women significantly decreased with age. Regarding TMM/BMI, there was no significant difference in men, but there was a significant difference between females in the young-old and old-old groups (p < 0.001). TMM/BMI was significantly correlated with sagittal vertical axis (SVA) and knee flexion angle (KF) in both sexes. In females, TMM/BMI was significantly correlated with thoracic kyphosis in the young-old group, whereas in the old-old group, TMM/BMI was correlated with SVA, PI-LL, and KF. CONCLUSIONS: TMM was related to trunk anteverion and lower extremity alignment in both sexes. However, the relationship between TMM on alignment differs between sexes. Thoracic hyperkyphosis in young-old adults indicated a decrease in muscle mass, which may be a sign of future malalignment.
Asunto(s)
Cifosis , Lordosis , Humanos , Femenino , Masculino , Anciano , Anciano de 80 o más Años , Caracteres Sexuales , Radiografía , Cifosis/diagnóstico por imagen , Extremidad Inferior/diagnóstico por imagen , Músculos , Lordosis/diagnóstico por imagenRESUMEN
BACKGROUND: Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months. METHODS: This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients' background. RESULTS: Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D'Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation. CONCLUSIONS: Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.
RESUMEN
PURPOSE: This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve. METHODS: In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2-4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography. RESULTS: The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve. CONCLUSIONS: The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.
Asunto(s)
Tornillos Pediculares , Escoliosis , Fusión Vertebral , Humanos , Anciano , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Tomografía Computarizada por Rayos X , Fusión Vertebral/métodosRESUMEN
PURPOSE: To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty. METHODS: We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SSpre post and Δstanding SSpre post, respectively. We statistically analysed the correlations between Δsupine SS pre post and preoperative spinal parameters to determine the most useful predictor of Δ supine SSpre post. RESULTS: The mean Δsupine SSpre post of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SSpre post of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SSpre post > 20°. The Δsupine SS pre post was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SSpre post, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12). CONCLUSION: Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Adulto , Posición Supina , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios Retrospectivos , Pelvis/diagnóstico por imagen , Pelvis/cirugía , Sacro/diagnóstico por imagen , Sacro/cirugíaRESUMEN
PURPOSE: We used the Hamamatsu formula as an indicator of correction goals in surgery for adult spinal deformity (ASD). However, it is reported that correction according to Global Alignment and Proportion (GAP) score and the Roussouly algorithm reduces implant-related complications. The purpose of this study was to validate three preoperative plannings for the incidence of complications. METHODS: Patients who underwent ASD surgery and followed up for 5 years were included. The Hamamatsu formula was also divided into three groups: ideal (I), moderate (M), and under (U). The GAP score was divided into three groups: proportioned (P), moderately disproportioned (MD), and severely disproportioned (SD). Patients who met the postoperative Roussouly classification algorithm were defined as the restored (R) group and those who did not were defined as the non-restored (NR) group. Proximal junctional kyphosis (PJK) and rod fractures were investigated. RESULTS: In the Hamamatsu formula, there were 51, 108, and 44 patients in Groups I, M, and U, respectively, with no significant differences in their complications. In the GAP score, there were 45, 71, and 87 patients in the P, MD, and SD group, respectively, with no significant differences in their complications. In the Roussouly classification, there were 102 and 101 patients in the R and NR group, respectively, with a significant difference in their complication rate (R/NR = 51%:70%; P = 0.005). PJK was significantly lower in the R group (R/NR = 15%:30%; P = 0.010). CONCLUSION: Correction according to the Roussouly algorithm is useful for the prevention of mechanical complications, especially PJK.
Asunto(s)
Cifosis , Fusión Vertebral , Adulto , Humanos , Fusión Vertebral/efectos adversos , Estudios Retrospectivos , Cifosis/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiologíaRESUMEN
STUDY DESIGN: Retrospective multicenter study. OBJECTIVES: To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury. SETTING: Thirty-three medical institutions in Japan. METHODS: This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed. RESULTS: After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3-17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%). CONCLUSION: Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.
Asunto(s)
Médula Cervical , Traumatismos de la Médula Espinal , Anciano , Médula Cervical/lesiones , Vértebras Cervicales/cirugía , Estudios de Cohortes , Humanos , Parálisis/complicaciones , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older. METHODS: Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients' backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted. RESULTS: One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively. CONCLUSIONS: The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.
Asunto(s)
Fracturas Óseas , Traumatismos del Cuello , Traumatismos de la Médula Espinal , Fracturas de la Columna Vertebral , Fusión Vertebral , Anciano , Fracturas Óseas/complicaciones , Humanos , Estudios Retrospectivos , Traumatismos de la Médula Espinal/cirugía , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/efectos adversos , CaminataRESUMEN
BACKGROUND: Condoliase-induced chemonucleolysis is a less invasive treatment for lumbar disc herniation (LDH); however, its long-term clinical outcomes remain unclear. We investigated 2-year clinical outcomes and assess radiographs after chemonucleolysis with condoliase. METHODS: We enrolled patients with LDH who received condoliase therapy, with a minimum follow-up period of two years. Sixty-seven patients (44 men, 23 women; mean age, 46.7 ± 18.0 years) were analyzed. Time-course changes in disc height, disc degeneration, and herniation size were assessed. For clinical outcomes assessment, visual analog scale (VAS) scores for leg and back pain and the Oswestry disability index (ODI) were obtained at baseline and the 3-month, 1-year, and 2-year follow-ups. We obtained a questionnaire from these patients at two years to assess satisfaction and recommendation. Condoliase therapy was considered to be effective in patients whose VAS score for leg pain improved by ≥ 50% at 2 years from baseline and who did not require surgery. RESULTS: Condoliase therapy was effective in 51 patients (76.1%). Eight patients (11.9%) required surgery due to ineffectiveness of the therapy. Condoliase therapy was ineffective in five out of six patients with a history of discectomy. The ODI and VAS scores for leg and back pain significantly improved from three months to two years. Of the patients, 80% satisfied with their outcomes, and 85% recommended this therapy. Progression of disc degeneration was observed in 57.1% of patients at three months; however, 30% recovered to baseline at two years. The mean disc height decreased at three months, but recovered slightly at one year and remained stable until two years. No recurrent disc herniation was observed. CONCLUSIONS: Chemonucleolysis with condoliase was effective in 78% of patients with LDH for 2 years. Chemonucleolysis-induced disc degeneration was slightly recovered and maintained for two years post-injection. This treatment resulted in high patient satisfaction and recommendations.
RESUMEN
BACKGROUND: Condoliase-induced chemonucleolysis is a less-invasive alternative treatment for lumbar disc herniation (LDH); however, its long-term clinical outcome is still unclear. This study aimed to investigate 1-year clinical outcomes and assess radiographs after chemonucleolysis with condoliase. METHODS: We enrolled patients with LDH who received condoliase injection with a follow-up period of >1 year. Sixty patients (37 men, 23 women; mean age, 44.5 ± 18.9 years; mean follow-up period, 22.0 ± 6.0 months) were analyzed. Changes in disc height and degeneration were evaluated using magnetic resonance imaging. Visual analog scale (VAS) scores for leg and back pain and the Oswestry disability index (ODI) were obtained. All data were assessed at baseline, 1-month, 3-month, and 1-year follow-up. RESULTS: Surgical treatment was subsequently required in 8 patients (12.5%) after condoliase therapy. Their ODI and VAS scores for leg pain and back pain significantly improved at 1 year, as in those who received condoliase therapy only. On MRI, progression of Pfirrmann grade was observed in 23 patients (44.2%) at 3 months; however, 8 patients recovered to baseline at 1 year. The mean disc height decreased at 3 months; however, it recovered at 1 year. Disc height recovery (disc recovery rate >50%) was observed in 30.8% of the patients. Patients with disc height recovery were significantly younger than those without. Patients with longer symptom duration (≥1 year) showed significantly lower rates of effectiveness compared with those with shorter symptom durations (<1 year). CONCLUSIONS: Chemonucleolysis with condoliase is a safe and minimally invasive treatment. Disc degeneration induced by chemonucleolysis could be recovered, particularly in younger patients. Prolonged symptom duration had adverse effects on outcome; thus, therapeutic intervention at the optimal time is needed.