Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training. / [Artículo traducido] Acuerdo inter- e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC - surgical site infection, hematoma, and/or dehiscence - at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis. / [Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC -surgical site infection, hematoma, and/or dehiscence- at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=.044). There was no difference between groups on 90 days survival rate (p=.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Factors associated with lumbar disc hernia recurrence after microdiscectomy. / Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía.

INTRODUCTION: Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. OBJECTIVE: To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. MATERIALS AND METHODS: Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. RESULTS: 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. DISCUSSION: Previous studies show increased disc height and young patients as possible factors associated with recurrence. CONCLUSION: In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence.

Quantified electroencephalographic changes in depressed patients with and without dementia.

We carried out quantified electroencephalograms (qEEG) in 17 patients with probable Alzheimer's disease (AD), who also met the DSM-III-R criteria for either dysthymia or major depression, and 18 AD patients with comparable intellectual impairment but no depression, 13 patients with depression but no AD, and 10 age-matched normal controls. There was a significant effect for depression in alpha relative power: depressed patients (with or without AD) showed a significantly lower alpha relative power in the right posterior region as compared to nondepressed patients; however, this change was observed over the right hemisphere in depressed non-AD patients, and in left, medial, and right posterior regions in depressed-AD patients. Depressed patients without AD showed a significant global decrease in delta power, whereas depressed patients with AD showed significant increments in delta power in posterior brain areas. In conclusion, AD patients with depression showed qEEG changes that were significantly different from qEEG changes in depressed non-AD patients.

Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease.

OBJECTIVE: The purpose of this study was to examine the prevalence, risk factors, and correlates of depression among patients with Alzheimer's disease. METHOD: A consecutive series of 103 patients with probable Alzheimer's disease were examined with a structured psychiatric interview and were assessed for the presence of cognitive impairments, deficits in activities of daily living, social functioning, and anosognosia. RESULTS: Fifty-one percent of the patients had depression (28% had dysthymia and 23% major depression). Women had a significantly higher prevalence of both major depression and dysthymia than men. Depressed and nondepressed patients had a similar frequency of family and personal histories of depression, a similar frequency of personality disorders before the onset of depression, and no significant differences in cognitive deficits and impairment in activities of daily living. Dysthymia usually started after the onset of dementia and was significantly more prevalent in the early stages of dementia; patients with dysthymia had a significantly better awareness of intellectual deficits than patients with major or no depression. On the other hand, patients with major depression had an earlier onset of depression (half of them before the onset of dementia), and the prevalence of major depression was similar across the different stages of the illness. CONCLUSIONS: This study demonstrates a high prevalence of dysthymia and major depression among patients with probable Alzheimer's disease. While dysthymia may be an emotional reaction to the progressive cognitive decline, major depression may be related to biological factors.

Quantified electroencephalographic correlates of neuropsychological deficits in Alzheimer's disease.

The authors examined relationships between quantified EEG (qEEG) variables and neuropsychological performance in 54 consecutive patients with probable Alzheimer's disease (AD). Patients were studied with qEEG and a neuropsychological battery that assessed memory, attention, verbal functions, set-shifting abilities, and procedural learning. More severe memory, attention, and verbal deficits were significantly correlated with lower alpha relative power, and increased theta relative power was significantly correlated with poor set-shifting abilities. No qEEG variables were significantly correlated with the procedural learning task. These correlations between deficits in specific cognitive domains and qEEG bands suggest that qEEG may have an important role in the investigation of the cognitive deficits in AD.

Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates.

The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 patients with Alzheimer's disease attending a neurology clinic, and 20 age comparable normal controls, were examined. Based on the unified Parkinson's disease rating scale (UPDRS) findings, 18 patients (23%) met criteria for parkinsonism, 44 (56%) had isolated extrapyramidal signs, and 16 (21%) had no extrapyramidal signs. Whereas the control group showed a similar prevalence of isolated extrapyramidal signs (57%), none of them showed parkinsonism. No significant differences were found for age, sex, duration of illness, and severity of dementia among the three Alzheimer's disease groups. Patients with Alzheimer's disease-parkinsonism, however, showed a significantly higher frequency of major depression and dysthymia and significantly higher Hamilton depression scores than patients with isolated or no extrapyramidal signs. Patients with Alzheimer's disease-parkinsonism also showed significantly more deficits on frontal lobe related tasks such as the Wisconsin card sorting test, trail making test, and verbal fluency, as well as on tests of constructional praxis and abstract reasoning than patients with Alzheimer's disease but no extrapyramidal signs. In conclusion, the study showed a specific association between Alzheimer's disease and parkinsonism, as well as significant relations between parkinsonism, deficits in executive functions, and depression among patients with Alzheimer's disease.

A SPECT study of parkinsonism in Alzheimer's disease.

The authors examined the presence of significant regional cerebral blood flow (rCBF) differences between Alzheimer's disease (AD) patients with and without extrapyramidal signs (EPS). Nine patients with probable AD and EPS (resting tremor or rigidity and bradykinesia) and 9 AD patients without EPS, comparable in age, duration of illness, and global cognitive decline, were studied with [99mTc]HMPAO SPECT. Patients with AD and EPS showed significantly lower rCBF in the superior frontal, superior temporal, and parietal regions of the left hemisphere than AD patients without EPS. Rigidity and bradykinesia independently accounted for the decreased rCBF in these areas. These findings suggest that the presence of EPS in AD may result from dysfunction in specific brain regions.

Quantified electroencephalographic changes in Parkinson's disease with and without dementia.

We examined the presence of quantified electroencephalographic (qEEG) differences between Parkinson's disease (PD) patients with and without dementia, and a group of age-comparable normal controls. While there were no significant differences in relative power in any of the qEEG bands between PD patients without dementia and normal controls, PD patients showed a significantly greater reactivity in the alpha band. On the other hand, PD patients with dementia showed significantly less alpha and more theta relative power than both the normal control and the PD without dementia groups. When PD patients with dementia were compared with a group of patients with Alzheimer's disease (AD) and a similar severity of dementia, no significant between-group differences were found in any of the qEEG bands. In conclusion, while our study demonstrated no significant qEEG differences between non-demented PD patients and normal controls, PD patients with dementia showed qEEG changes similar to those observed in patients with AD.

Quantified electroencephalographic correlates of relative frontal or parietal hypoperfusion in dementia.

The authors examined the presence of specific quantified electroencephalographic (qEEG) changes in dementia patients with relatively lower frontal or parietal blood perfusion as demonstrated by SPECT. Over all brain regions, patients with relatively lower parietal perfusion showed significantly higher theta relative power than demented patients with relatively lower frontal perfusion or normal control subjects. Dementia patients with relatively lower frontal perfusion showed no differences from age-comparable normal control subjects in qEEG variables. These findings 1) suggest that usefulness of qEEG for the diagnosis of dementia is restricted to a subgroup of patients with the typical SPECT pattern of parietal blood hypoperfusion and 2) demonstrate that the qEEG changes typical of dementia are not related to perfusion deficits in frontal brain areas.

Anosognosia in Alzheimer's disease: a study of associated factors.

The authors examined the prevalence and correlates of anosognosia in a consecutive series of patients with probable Alzheimer's disease (AD). Patients were examined with the Anosognosia Questionnaire-Dementia (AQ-D), which showed good reliability and validity. On the basis of the AQ-D scores, patients were divided into those with anosognosia (n = 21) and those without anosognosia (n = 52). Patients with anosognosia showed a significantly longer duration of illness, more severe cognitive impairments and deficits in activities of daily living, and higher mania and pathological laughing scores than AD patients without anosognosia. These findings suggest that anosognosia in AD may be part of a specific neuropsychiatric syndrome.