DNA Polymorphisms in Pregnant Women with Sticky Platelet Syndrome.

Sticky platelet syndrome (SPS) is a thrombophilia caused by the increased aggregability of platelets in response to the addition of low concentrations of epinephrine (EPI) and/or adenosine diphosphate (ADP). Some of the single nucleotide polymorphisms (SNP), alleles and haplotypes of platelet glycoprotein receptors were proved to have a role in the etiology of thrombotic episodes When comparing SPS and the control group, in VEGFA rs3025039, the p value for both CC vs. TT and CT vs. TT analyses was <0.001. Interestingly, no minor TT genotype was present in the SPS group, suggesting the thrombotic pathogenesis of recurrent spontaneous abortions (RSA) in these patients. Moreover, we found a significant difference in the presence of AT containing a risky A allele and TT genotype of ALPP rs13026692 (p = 0.034) in SPS patients when compared with the controls. Additionally, we detected a decreased frequency of the GG (CC) genotype of FOXP3 rs3761548 in patients with SPS and RSA when compared with the control group (p value for the CC (GG) vs. AA (TT) 0.021). This might indicate an evolutionary protective mechanism of the A (T) allele in the SPS group against thrombotic complications in pregnancy. These results can be used for antithrombotic management in such pregnant patients.

The Relation of Patient Expectations, Satisfaction, and Outcome in Surgery of the Cervical Spine: A Prospective Study.

STUDY DESIGN: We performed a prospective nonblinded single center observational study. OBJECTIVE: To investigate the relationship between expectations, outcome, and satisfaction with the outcome in patients undergoing cervical spine stabilization surgery. SUMMARY OF BACKGROUND DATA: In modern healthcare, patient-reported outcome measures and patient satisfaction have become an important aspect of quality control. Therefore, outcome benchmarks for specific diseases are highly desired. Numerous studies have investigated patient-reported outcome measures and what constitutes satisfaction in degenerative lumbar spine disease. In cervical spine surgery, it is less clear what drives the postoperative symptom burden and patient satisfaction and how this depends on the primary diagnosis and other patient factors. METHODS: This was a prospective, single center, observational study on patients undergoing cervical spine stabilization surgery for degenerative disease, trauma, infection, or tumor. Using the visual analogue scale for neck and arm pain, the neck disability index (NDI), the modified Japanese Orthopedic Association Score (mJOA) and patient-reported satisfaction, patient status and expectations before surgery, at discharge, 6 and 12 months after surgery were evaluated. RESULTS: One hundred five patients were included. Score-based outcome correlated well with satisfaction at 6 and 12 months. Except for low NDI expectations (≥15 points) that correlated with dissatisfaction, expectations in no other score were correlated with satisfaction. Expectations did influence the outcome in some subgroups and meeting expectations resulted in higher rates of satisfaction. Pain reduction plays an important role for satisfaction, independently from the predominant symptom or pathology. CONCLUSION: Satisfaction correlates well with outcome. Meeting expectations did influence satisfaction with the outcome. The NDI seems to be a valuable preoperative screening tool for poor satisfaction at 12 months. In degenerative pathology, pain is the predominant variable influencing satisfaction independently from the predominant symptom (including myelopathy). LEVEL OF EVIDENCE: 5.

L5 corpectomy-the lumbosacral segmental geometry and clinical outcome-a consecutive series of 14 patients and review of the literature.

PURPOSE: We analyzed the lumbosacral segmental geometry and clinical outcome in patients undergoing L5 corpectomy. METHODS: Fourteen consecutive patients who underwent L5 (n = 12) or L4 + 5 (n = 2) corpectomy at our department between January 2010 and April 2015 were included. All patients underwent a baseline physical and neurologic examination on admission. The diagnostic routine included MRI and CT scans and, if possible, an upright X-ray of the lumbar spine before and after surgery. The local lordosis angle [L4(L3)-S1] was measured. RESULTS: The most common pathology was infection (N = 7), followed by neoplastic disease (n = 3), pseudarthrosis (n = 2) after previous spinal fusion procedures and burst fractures (n = 2) of the L5 vertebral body. We observed seven complications (2 intraoperative; 5 postoperative) in five (36%) patients. Three patients needed revision surgery because of cage subsidence and/or dislodgement (21%). Additional anterior plating was used in two of the revision surgeries to secure the cage. Two spondylodiscitis patients (14%) with complications died of sepsis. Of the 12 remaining patients, 8 were available for follow-up. CONCLUSION: L5 corpectomy is a technically challenging but feasible procedure even though the overall complication rate can be as high as 36%. The radiologic and clinical outcome seems to be better in patients with a small lordosis angle between L4(L3) and S1, since an angle of >50 degrees seems to facilitate cage dislodgement. Anterior plating should be considered in these cases to prevent implant failure.

Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature.

BACKGROUND: Minimally invasive spine surgery (MISS) has been increasingly advocated during the last decade with new studies being reported every year. Minimally invasive spine procedures, such as minimally invasive transforaminal interbody fusion (MI-TLIF), have been introduced to reduce approach-related muscle trauma, to minimise blood loss, and to achieve faster wound healing, quicker ambulation and earlier patient discharge. METHODS: The aim of this article was to give a comprehensive review of the available English literature comparing open TLIF with MI-TLIF techniques published or available online between 1990 and 2014 as identified by an electronic database search on http://www.ncbi.nlm.nih.gov/pubmed . Fourteen relevant studies comparing MI-TLIF and open TLIF cohorts could be identified. RESULTS AND CONCLUSION: MI-TLIF seems to be a valid alternative to open TLIF. Both methods yield good clinical results with similar improvements of Oswestry Disability Index (ODI) and visual analogue scale (VAS) on follow-up. There seems to be no significant differences in clinical outcome and fusion rates on comparison. These results are consistent throughout all reported studies in this review. The most pronounced benefits of MI-TLIF are a significant reduction of blood loss, shorter lengths of hospital stay (LOHS) and lower surgical site infection rates. On the downside, MI-TLIF seems to be associated with significantly higher intraoperative radiation doses, a shallow learning curve, at least in the beginning, longer operating times and potentially more frequent implant failures/cage displacements and revision surgeries.

Outcome after Surgical Treatment for Late Recurrent Lumbar Disc Herniations in Standard Open Microsurgery.

PURPOSE: There is a lack of studies highlighting the outcome by different scores or parameters after surgery for recurrent disc herniations of the lumbar spine at the initial herniation site. This study assessed the quality of life after surgical treatment of recurrent herniations with different standardized validated outcome instruments. METHODS: During a 24-month period, 64 patients underwent (microscope assisted) surgery for recurrent disc herniations of the lumbar spine. The postoperative quality of life was tested with Short Form-36, the Oswestry Disability Index, the EuroQol health status 5D, and Prolo questionnaires. Leg and back pain before and after surgery was assessed. RESULTS: The patients showed a good overall outcome, but still not satisfying enough compared with the very good surgical results reported in the literature, for the surgical treatment of primary disc herniations. CONCLUSIONS: Patients have to be informed carefully before surgery of recurrent lumbar disc herniations because of the less-promising outcome than after first time surgery for a lumbar disc herniation.