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BACKGROUND: This study aimed to investigate the relationship between femoral neck fractures and sarcopenia. METHODS: This was a retrospective analysis of 92 patients with femoral neck fractures, from September 2017 to March 2020, who were classified into high ambulatory status (HG) and low ambulatory status (LG) groups. Ambulatory status was assessed before surgery, one week after surgery, at discharge, and during the final follow-up. To evaluate sarcopenia, muscle mass and fatty degeneration of the muscles were measured using preoperative CT. An axial slice of the superior end of the L5 vertebra was used to evaluate the paraspinal and psoas muscles, a slice of the superior end of the femoral head for the gluteus maximus muscle, and a slice of the inferior end of the sacroiliac joint for the gluteus medius muscle. The degeneration of the muscles was evaluated according to the Goutallier classification. RESULTS: The cross-sectional area of the gluteus medius and paraspinal muscles was significantly correlated with ambulatory status before the injury, at discharge, and during the final follow-up. CONCLUSIONS: Measurement of the gluteus medius and paraspinal muscles has the potential to evaluate sarcopenia and predict ambulatory status after femoral neck fractures.
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Fraturas do Colo Femoral , Sarcopenia , Humanos , Sarcopenia/diagnóstico por imagem , Sarcopenia/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Músculos Psoas/diagnóstico por imagem , Nádegas/diagnóstico por imagem , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Músculos ParaespinaisRESUMO
BACKGROUND: Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. METHODS: This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared. RESULTS: The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group. CONCLUSIONS: PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.
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Vértebras Lombares , Procedimentos Cirúrgicos Minimamente Invasivos , Duração da Cirurgia , Parafusos Pediculares , Espondilite , Vértebras Torácicas , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Espondilite/cirurgia , Espondilite/diagnóstico por imagem , Espondilite/microbiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Resultado do Tratamento , Reoperação , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: Recent studies have reported that confined high-intensity and diffuse low-intensity on sagittal T2-weighted magnetic resonance imaging (MRI) are distinctive features that are highly predictive of delayed union or nonunion on osteoporotic vertebral fracture (OVF). The objective of this study was to identify the characteristics of imaging findings predicting the risk for requiring surgical treatment in fresh OVF with poor prognostic features on MRI. METHODS: We conducted a retrospective study of 74 patients (17 men and 57 women with a mean age of 81.1 years) of OVF with the poor prognostic MRI findings. We compared the imaging findings between the surgery group (16 patients) and the conservative group (58 patients): vertebral instability defined as the difference between the vertebral collapse ratio in dynamic X-rays, and the grade of posterior wall injury (Grade I, no spinal canal encroachment; Grade II, <2 mm; Grade III, ≥2 mm) as well as the presence or absence of pedicle fracture (Grade I, none; Grade II, unilateral; Grade III, bilateral) on computed tomography. RESULTS: The mean vertebral instability was 24.0% ± 10.1% in the surgery group and 13.0% ± 7.8% in the conservative group, which was significantly different. Posterior wall injury in the surgery and conservative groups was Grade I in 0 and 29 cases, Grade II in 5 and 21 cases, and Grade III in 11 and 8 cases, respectively, constituting a significant difference. Pedicle fracture in the surgery and conservative groups was Grade I in 5 and 55 cases, Grade II in 6 and 2 cases, and Grade III in 5 and 1 case, respectively, also constituting a significant difference. CONCLUSIONS: The most high-risk OVF patients with poor prognostic MRI findings who required surgical treatment were those who exhibited greater vertebral instability as well as either more severe posterior wall injury or pedicle fracture. STUDY DESIGN: Retrospective clinical study.
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Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso de 80 Anos ou mais , Tratamento Conservador/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgiaRESUMO
BACKGROUND: Patients with adolescent idiopathic scoliosis (AIS) under brace treatment perceive stress, not only from scoliosis, but from wearing the brace itself. The Bad Sobernheim Stress Questionnaire-Brace (BSSQbrace) was developed to assess the level of psychological stress induced by brace treatment for AIS. However, a Japanese version of BSSQbrace had not yet been developed. METHODS: We developed a Japanese adaptation of the Bad Sobernheim Stress Questionnaire-Brace (JBSSQ-brace) through a guideline-based process to adapt assessment of the psychological effect of brace treatment for AIS in Japanese patients. We administered the JBSSQ-brace to 71 patients with AIS under brace treatment in our clinic. Internal consistency and reproducibility were analyzed using Cronbach's alpha and a test-retest method. RESULTS: We included 44 patients that responded adequately. JBSSQ-brace achieved excellent internal consistency (Cronbach's alpha = 0.84 for the first questionnaire, and 0.87 for the second) and substantial reproducibility (interclass correlation coefficient = 0.75). The average score for JBSSQ-brace was 16.5 and 16.8, and almost 40% of AIS patients felt a moderate-to-high stress from brace treatment. CONCLUSIONS: JBSSQ-brace is an effective instrument with which to evaluate the stress level from brace treatment in Japanese patients with AIS.
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Braquetes , Escoliose/psicologia , Estresse Psicológico/diagnóstico , Inquéritos e Questionários , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Reprodutibilidade dos Testes , TraduçõesRESUMO
After the Fukushima Daiichi-Nuclear Power Plant accident, environmental recovery was a major issue because a considerable amount of municipal solid waste incineration (MSWI) fly ash was highly contaminated with radioactive cesium. To the best of our knowledge, only a few studies have evaluated the detailed physicochemical properties of radioactive cesium in MSWI fly ash to propose an effective method for the solidification and reuse of MSWI fly ash. In this study, MSWI fly ash was sampled in Fukushima Prefecture. The physicochemical properties of radioactive cesium in MSWI fly ash were evaluated by particle size classification (less than 25, 25-45, 45-100, 100-300, 300-500, and greater than 500⯵m) and the Japanese leaching test No. 13 called "JLT-13". These results obtained from the classification of fly ash indicated that the activity concentration of radioactive cesium and the content of the coexisting matter (i.e., chloride and potassium) temporarily change in response to the particle size of fly ash. X-ray diffraction results indicated that water-soluble radioactive cesium exists as CsCl because of the cooling process and that insoluble cesium is bound to the inner sphere of amorphous matter. These results indicated that the distribution of radioactive cesium depends on the characteristics of MSWI fly ash.
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Césio/química , Cinza de Carvão , Eliminação de Resíduos , Carbono , Incineração , Metais Pesados , Tamanho da Partícula , Material Particulado , Resíduos SólidosRESUMO
Study Design: A post-hoc analysis of a prospective cohort study. Purpose: This study aimed to identify factors at the time of injury associated with declining activities of daily living (ADLs) in the chronic phase of osteoporotic vertebral fractures (OVFs) managed conservatively. Overview of Literature: Although a conservative approach is the treatment of choice for OVFs, ADLs do not improve or eventually decrease in some cases. However, the risk factors for ADL decline after the occurrence of OVFs, particularly the difference between those with or without initial bed rest, are unknown. Methods: A total of 224 consecutive patients with OVFs aged ≥65 years who received treatment within 2 weeks after the occurrence of injury were enrolled. The patients were followed up for 6 months thereafter. The criteria for evaluating the degree of independence were applied to evaluate ADLs. Multivariable analysis with a logistic regression model was performed to evaluate the risk factors for ADL decline. Results: In total, 49/224 patients (21.9%) showed a decline in ADLs. Of these, 23/116 patients (19.8%) in the rest group and 26/108 patients (24.1%) in the no-rest group experienced a decline in ADLs. In the logistic regression analyses, a diffuse low signal on T2- weighted magnetic resonance imaging (MRI) (odds ratio, 5.78; 95% confidence interval, 2.09-16.0; p=0.0007) and vertebral instability (odds ratio, 3.89; 95% confidence interval, 1.32-11.4; p=0.0135) were identified as independent factors in the rest and no-rest groups, respectively. Conclusions: In patients with acute OVFs, a diffuse low signal on T2-weighted MRI and severe vertebral instability were independently associated with ADL decline in patients treated with and without initial bed rest, respectively.
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We report a case of vertebral fracture in a patient with rod fractures after adult spinal deformity surgery, which occurred at the same level as the rod fractures, even though intervertebral bone fusion in the fusion range had been achieved. A 77-year-old female underwent corrective spinal surgery for adult spinal deformity from T12 to the pelvis but had a subsequent uppermost instrumented vertebral fracture, resulting in pseudarthrosis and severe kyphosis. The patient underwent proximal fusion extension to the T4, which improved alignment. A right-sided rod fracture at the lumbosacral junction occurred after 18 months; however, it showed no symptoms. After a month, the patient experienced severe low back pain with left leg pain and was diagnosed with bilateral rod fractures associated with L5 hyperextension vertebral fracture. The patient underwent revision surgery to repair the fractured rods with a multiple-rod construct. Rod fractures can occur even when bone fusion is achieved within the fusion range. When rod fractures are detected at the lumbosacral junction even if the interbody fusion was achieved, a hyperextension vertebral fracture may occur.
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The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation alone were retrospectively evaluated at nine affiliated hospitals since April 2016. The study included 31 patients (23 men and 8 women; mean age, 73.3 years). The clinical course of the patients and requirement of additional anterior surgery constituted the study outcomes. The postoperative numerical rating scale score for lower back pain was significantly smaller than the preoperative score (5.8 vs. 3.6, p = 0.0055). The preoperative local kyphosis angle was 6.7°, which was corrected to 0.1° after surgery and 3.7° at the final follow-up visit. Owing to failed infection control, three patients (9.6%) required additional anterior debridement and autogenous bone grafting. Thus, in this multicenter case series, a large proportion of patients with thoracolumbar pyogenic spondylitis could be treated with minimally invasive posterior fixation alone, thereby indicating it as a treatment option for pyogenic spondylitis.
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UPDATE: This article was updated on October 19, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1787, in the legend for Figure 2, the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (A/P) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." now reads "The vertebral collapse rate (in %) was defined as (1 - [A/P]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." On page 1788, in the section entitled "Data Collection," the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (anterior vertebral wall height/posterior vertebral wall height) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." now reads "The vertebral collapse rate (in %) was defined as (1 - [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." Finally, on page 1791, in Table IV, the footnote for the "Primary outcome" row that had read "N = 113 in the rest group and 99 in the no-rest group." now reads "N = 116 in the rest group and 108 in the no-rest group."
Although imaging findings that predict resistance to conservative treatment in patients with osteoporotic vertebral fracture (OVF) have recently been reported, no conservative treatment method has been standardized. In this study, the effects of initial bed rest on the outcomes of patients with OVF and in patients with and without poor prognostic findings on magnetic resonance imaging (MRI) were compared. This prospective cohort study at 2 facilities involved consecutive patients aged ≥65 years with OVF who began treatment within 2 weeks after their injury and were observed for 6 months. Patients at one hospital rested for 2 weeks (116 patients; mean age, 80.4 years), whereas those at the other hospital were not instructed to rest (108 patients; mean age, 81.5 years). Patients were further divided according to the presence or absence of poor prognostic MRI findings. The primary end point was the rate of transition to surgery; secondary end points included bone union rate, vertebral collapse progression, local kyphosis progression, and changes in activities of daily living (ADL). Forty-five patients in the rest group (including 3 who required surgery) and 37 patients in the no-rest group (including 9 who required surgery) had poor prognostic MRI findings. Although the difference in the rate of transition to surgery between the rest and no-rest groups did not reach significance among all patients (p = 0.06), the transition rate in the rest group was significantly lower (p = 0.02) in the patients with poor prognostic MRI findings. Both the bone union rate and changes in ADL were not significantly different between the rest and no-rest groups. The mean vertebral collapse progression was 6.4% in the rest group and 20.9% in the no-rest group (p < 0.001), and the mean local kyphosis progression was 2.4° in the rest group and 8.8° in the no-rest group (p < 0.001). Although bed rest is not recommended for all patients, hospitalized bed rest for 2 weeks reduced the number of patients with OVF who require surgery among patients with poor prognostic MRI findings. Bed rest also reduced progression of vertebral collapse and kyphosis, regardless of the MRI findings. Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Tratamento Conservador/efeitos adversos , Repouso em Cama/efeitos adversos , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Fraturas por Osteoporose/cirurgiaRESUMO
This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.
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Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Idoso , Vértebras Cervicais/fisiopatologia , Progressão da Doença , Feminino , Humanos , Japão , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Estudos Prospectivos , Amplitude de Movimento Articular , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
STUDY DESIGN: Prospective, nationwide case series. OBJECTIVE: To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL. MATERIALS AND METHODS: Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2-7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2-7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned. RESULTS: Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2-7 according to the type of OPLL, significant differences were observed in a range of motion at C2-7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging. CONCLUSIONS: This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery. LEVEL OF EVIDENCE: Level II.
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Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Doenças da Medula Espinal , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Ligamentos Longitudinais/cirurgia , Masculino , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Estudos Prospectivos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: It is unclear whether anterior cervical decompression and fusion (ADF) or laminoplasty (LMP) results in better outcomes for patients with K-line-positive (+) cervical ossification of the posterior longitudinal ligament (OPLL). The purpose of the study is to compare surgical outcomes and complications of ADF versus LMP in patients with K-line (+) OPLL. METHODS: The study included 478 patients enrolled in the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament and who underwent surgical treatment for cervical OPLL. The patients who underwent anterior-posterior combined surgery or posterior decompression with instrumented fusion were excluded. The patients with a follow-up period of fewer than 2 years were also excluded, leaving 198 patients with K-line (+) OPLL. Propensity score matching was performed on 198 patients with K-line (+) OPLL who underwent ADF (44 patients) or LMP (154 patients), resulting in 39 pairs of patients based on the following predictors for surgical outcomes: age, preoperative Japanese Orthopaedic Association (JOA) score, C2-7 angle, and the occupying ratio of OPLL. Clinical outcomes were assessed 1 and 2 years after surgery using the recovery rate of the JOA score. Complications and reoperation rates were also investigated. RESULTS: The mean recovery rate of the JOA score 1 year after surgery was 55.3% for patients who underwent ADF and 42.3% (p = 0.06) for patients who underwent LMP. Two years after surgery, the recovery rate was 53.4% for those who underwent ADF and 38.7% for LMP (p = 0.07). Although both surgical procedures yielded good results, the mean recovery rate of JOA scores tended to be higher in the ADF group. The incidence of surgical complications, however, was higher following ADF (33%) than LMP (15%; p = 0.06). The reoperation rate was also higher in the ADF group (15%) than in the LMP group (0%; p = 0.01). CONCLUSIONS: Clinical outcomes were good for both ADF and LMP, indicating that ADF and LMP are appropriate procedures for patients with K-line (+) OPLL. Clinical outcomes of ADF 1 and 2 years after surgery tended to be better than LMP, but the analysis did not detect any significant difference in clinical outcomes between the groups. Conversely, patients who underwent ADF had a higher incidence of surgery-related complications. When considering indications for ADF or LMP, benefits and risks of the surgical procedures should be carefully weighed.
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Pyogenic spondylitis is a challenging condition that requires early and accurate diagnosis for appropriate treatment. Most cases can be treated non-surgically or with minimally invasive surgical procedures; however, a combination of anterior debridement/bone grafting and posterior fixation is necessary for severe cases. We encountered a case of lumbar pyogenic spondylitis treated with anterior debridement and autogenous bone grafting after percutaneous endoscopic discectomy drainage (PEDD) with percutaneous pedicle screw (PPS) fixation. The continuous pus oozing from the PEDD drainage tube wound was characteristic in this case, and the pus was considered to be caused by secondary infection/microbial substitution. The discharge immediately stopped and healed after anterior debridement and autogenous bone grafting. Escherichia coli was first detected as the causative bacterium, and Corynebacterium amycolatum and Corynebacterium striatum were detected as the cause of secondary infection/microbial substitution. The possibility of secondary infection/microbial substitution should be considered when the clinical course worsens.
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The chemical states of heavy metals and radioactive Cs were estimated in fly ash sampled at Fukushima prefecture, Japan. Estimating the speciation of incinerator fly ash is important to ensure an appropriate and efficient management of fly ash generated from disaster-related waste. In this study, fly ash collected at a waste incineration facility in Fukushima prefecture was treated using a sequential extraction test. The test results indicated that the solubility behavior of radioactive Cs was similar to that of NaCl and KCl, and approximately 60% of radioactive Cs was included as water-soluble chloride compounds in the fly ash sample. Most heavy metals eluted in three fractions, in the extraction steps for carbonate-bound, free oxide, and bound to organic matter species. The chemical states of elements in the three non-water-soluble fractions and residue showed minimal elution into the environment. Therefore, most heavy metals in the fly ash exhibited minimal elution into the environment.
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Metais Pesados , Eliminação de Resíduos , Acidentes , Carbono , Césio , Cinza de Carvão , Incineração , Metais Pesados/análise , Material Particulado , Resíduos Sólidos/análiseRESUMO
BACKGROUND: Implants coated with fibroblast growth factor-2 (FGF-2)-apatite composite layers were previously reported to enhance soft-tissue formation, bone formation, and angiogenesis around the implants owing to the biological activity of FGF-2. However, it is unclear whether the chemistries of the material and surface of implants have some impact on the retention of the biological activity of FGF-2 in FGF-2-apatite composite layers on them. Since magnitude of the impact should be evaluated for extensive application of the composite layer to coat various implants, following items were examined; (1) surface chemistries of six implants, (2) mitogenic activities of FGF-2 in FGF-2-apatite composite layers on the implants, and (3) improved synthesis method of the composite layer for retention of the mitogenic activity of FGF-2. HYPOTHESIS: The biological activity of FGF-2 in the composite layer is affected by the chemistries of the material and surface of implants. MATERIALS AND METHODS: Six commercial products of pins and screws having different surface chemistries were coated with FGF-2-apatite composite layers. The composite layers were quantitatively analyzed for calcium (Ca), phosphorus (P) and FGF-2, and also evaluated the mitogenic activities of FGF-2. Improvement of the synthesis method was then attempted using two pin products. RESULTS: Each commercial product had a chemically and morphologically characteristic surface. FGF-2-apatite composite layers were formed on all the commercial products. Although the Ca, P, and FGF-2 contents (4.7±0.9µg/mm, 2.2±0.4µg/mm, and 21.1±3.7ng/mm, respectively) and the Ca/P molar ratios (1.69±0.01) of the composite layers were almost the same, rate of retention of the mitogenic activity of FGF-2 in the composite layers significantly decreased on some pin products (3/12-4/12). The decrease in rate of retention of the mitogenic activity of FGF-2 was prevented by a two-step synthesis method to form a composite layer on a precoating with calcium phosphate (9/12-12/12). DISCUSSION: The chemistries of the implant surfaces had a significant impact on the retention of the mitogenic activity of FGF-2 in the composite layers formed on the implant. The two-step synthesis method was useful to retain mitogenic activity of FGF-2 regardless of the surface chemistries of the implants. The two-step synthesis method has potential to expand the applicability of FGF-2-apatite composite layers to a wider range of implants. LEVEL OF EVIDENCE: III, Case control in vitro study.
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Apatitas , Fator 2 de Crescimento de Fibroblastos , Pinos Ortopédicos , Estudos de Casos e Controles , Materiais Revestidos Biocompatíveis , Fator 2 de Crescimento de Fibroblastos/farmacologia , Humanos , Osteogênese , Propriedades de Superfície , TitânioRESUMO
OBJECTIVES: To describe the novel technique of continuous local antibiotic perfusion (CLAP) for a surgical site infection (SSI) after instrumented spinal surgery. METHODS: CLAP was applied to 4 continuous patients at our institution who developed SSI after instrumented spinal surgery. RESULTS: All 4 patients were successfully treated and the infection was controlled. The implant was retained in all patients. The duration of CLAP ranged from 2 to 3 weeks. The blood level of the antibiotic used (gentamicin) at 1 week after the initiation of CLAP did not increase in any patient. No other adverse events occurred in any patient. Dramatic improvements in laboratory parameters, including the white blood cell (WBC) counts and C-reactive protein (CRP) levels were seen in every patient at 1 week after the initiation of CLAP. CONCLUSIONS: CLAP controlled the infection without severe adverse events in all 4 patients, and the implants were retained. Despite its cost and the discomfort of patients, CLAP may become an option for the treatment of SSIs after instrumented spinal surgery. A large number of case series are needed to verify the efficacy of CLAP for patients with SSIs after instrumented spinal surgery.
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Antibacterianos , Infecção da Ferida Cirúrgica , Antibacterianos/uso terapêutico , Humanos , Procedimentos Neurocirúrgicos , Perfusão , Próteses e Implantes , Infecção da Ferida Cirúrgica/tratamento farmacológicoRESUMO
STUDY DESIGN: A retrospective analysis of prospectively collected data. OBJECTIVE: This study aimed to create a prognostic model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using machine learning (ML). SUMMARY OF BACKGROUND DATA: Determining surgical outcomes helps surgeons provide prognostic information to patients and manage their expectations. ML is a mathematical model that finds patterns from a large sample of data and makes predictions outperforming traditional statistical methods. METHODS: Of 478 patients, 397 and 370 patients had complete follow-up information at 1 and 2âyears, respectively, and were included in the analysis. A minimal clinically important difference (MCID) was defined as an acquired Japanese Orthopedic Association (JOA) score of ≥2.5 points, after which a ML model that predicts whether MCID can be achieved 1 and 2âyears after surgery was created. Patient background, clinical symptoms, and imaging findings were used as variables for analysis. The ML model was created using LightGBM, XGBoost, random forest, and logistic regression, after which the accuracy and area under the receiver-operating characteristic curve (AUC) were calculated. RESULTS: The mean JOA score was 10.3 preoperatively, 13.4 at 1âyear after surgery, and 13.5 at 2âyears after surgery. XGBoost showed the highest AUC (0.72) and high accuracy (67.8) for predicting MCID at 1âyear, whereas random forest had the highest AUC (0.75) and accuracy (69.6) for predicting MCID at 2âyears. Among the included features, total preoperative JOA score, duration of symptoms, body weight, sensory function of the lower extremity sub-score of the JOA, and age were identified as having the most significance in most of ML models. CONCLUSION: Constructing a prognostic ML model for surgical outcomes in patients with OPLL is feasible, suggesting the potential application of ML for predictive models of spinal surgery.Level of Evidence: 4.
Assuntos
Ligamentos Longitudinais , Osteogênese , Vértebras Cervicais/diagnóstico por imagem , Humanos , Ligamentos Longitudinais/patologia , Ligamentos Longitudinais/cirurgia , Aprendizado de Máquina , Estudos Retrospectivos , Resultado do TratamentoRESUMO
STUDY DESIGN: A prospective multicenter study. OBJECTIVE: To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy. METHODS: This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2âyears. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores. RESULTS: Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2âyears postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates. CONCLUSION: The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 2.
Assuntos
Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminoplastia/efeitos adversos , Ligamentos Longitudinais , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.
RESUMO
STUDY DESIGN: This was a prospective multicenter study. OBJECTIVE: The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. MATERIALS AND METHODS: We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. RESULTS: Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. CONCLUSIONS: In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. LEVEL OF EVIDENCE: Level III.