Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis.

PURPOSE: Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to identify relationships between postoperative cervical sagittal alignment and HRQOL in AIS. METHODS: The study and control groups comprised 67 AIS patients (51 girls and 16 boys). All underwent anteroposterior and lateral plain radiography and completed clinical questionnaires. The radiographic parameters investigated were pre- and postoperative C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, T1 slope minus C2-C7 lordosis (TS-CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). The Korean version of the SRS-22 questionnaire and the previously validated Short Form-36 (SF-36) outcome questionnaire were administered to evaluate HRQOL at last follow-up visits. Statistical analysis was performed to determine the significances of differences between preoperative and last follow-up radiological findings. In addition, correlations between radiological parameters and clinical questionnaire scores were sought. RESULTS: Radiological sagittal parameters were found to be significantly increased after surgical correction in terms of C2-C7 lordosis (3.5 ± 11.4), C2-C7 SVA (1.5 ± 6.0), T1 slope (3.5 ± 6.1), and TK (6.0 ± 8.1). However, no significant difference was observed for TS-CL, LL, PT, SS, and PI (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and questionnaire scores. Multiple regression analysis was performed to identify predictors of HRQOL, and the results obtained revealed that postoperative T1 slope significantly predicted SRS, PCS, and MCS scores and that postoperative C2-C7 SVA predicted SRS scores. CONCLUSIONS: Changes in cervical sagittal parameters were significant after deformity correction in AIS patients. Correlation analysis revealed significant relationships between postoperative radiographic parameters and HRQOL. In particular, T1 slope and C2-C7 SVA were found to be significant predictors of HRQOL in AIS patient.

Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis.

PURPOSE: Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in ankylosing spondylitis (AS) patients. The aim of this study was to identify relationships between cervical sagittal alignment and HRQOL in AS. METHODS: The study and control groups comprised 102 AS patients (15 women and 87 men) and age- and sex-matched 50 controls, respectively. All underwent anteroposterior and lateral radiographs and completed clinical questionnaires. The radiographic parameters examined were C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope and T1 slope minus C2-C7 lordosis (TS-CL). A visual analogue scale (VAS 0-10) score for neck pain, the neck disability index (NDI), neck pain and disability (NPAD) scale and bath ankylosing spondylitis disease activity index (BASDAI) were administered to evaluate QOL. Statistical analysis was performed to determine the significances of differences between the study and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. RESULTS: AS patients and controls were found to be different significantly in terms of C2-C7 SVA, T1 slope, and TS-CL. However, no significant intergroup difference was observed for C2-C7 lordosis (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and QOL. Multiple regression analysis was performed to identify predictors of QOL, and the results obtained revealed that C2-C7 SVA significantly predicted VAS, NDI, and NPAD scores and that age predicted NPAD score. CONCLUSIONS: Cervical sagittal parameters were found to be significantly different in AS patients and normal controls. Correlation analysis revealed significant relationships between radiographic parameters and QOL. In particular, C2-C7 SVA was found to be a significant predictor of QOL in AS patient.

Validation of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26) in Korean population.

We aimed to evaluate the reliability and validity of the adapted Korean version of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26). Translation/retranslation of the English version of QUALEFFO was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale measure of pain, QUALEFFO-26 and the previously validated Short Form-36 (SF-36) were mailed to 162 consecutive patients with osteoporosis. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's α were conducted. Construct validity was also evaluated by comparing the responses of QUALEFFO-26 with the responses of SF-36 using Pearson's correlation coefficient. Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The QUALEFFO-26 showed good test/retest reliability (QUALEFFO-26: 0.8271). Internal consistency of Cronbach's α was found to be very good (QUALEFFO-26: 0.873). The Korean version of QUALEFFO-26 showed good significant correlation with SF-36 total score and with single SF-36 domains scores. The adapted Korean version of the QUALEFFO-26 was successfully translated and showed acceptable measurement properties and, as such, is considered suitable for outcome assessments in the Korean-speaking patients with osteoporosis.

The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery.

PURPOSE: Little data are available regarding the influence of psychiatric factors on chronic dysphagia after anterior cervical spine surgery. The purpose of this study was to identify associations between psychiatric factors and the development of chronic dysphagia in patients after anterior cervical spine surgery. METHODS: The authors prospectively examined 72 patients with degenerative disc disease of the cervical spine who were treated by single-level anterior cervical discectomy and fusion. Demographic data including age, gender, body mass index, and smoking status were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Neck Disability Indices (NDI), and the Neck Pain and Disability Scale (NPDS) were assessed before surgery and at final follow-up. Psychiatric conditions were evaluated using the Zung depression scale and the Zung anxiety scale. At 1 year postoperatively, patients were contacted by telephone to determine the presence and severity of dysphagia. For statistical analyses, patients were divided into two groups: group I, those with No or Mild dysphagia; and group II, those with Moderate or Severe dysphagia at 1 year after surgery. Potential risk factors of chronic dysphagia were evaluated by multivariate logistic regression analysis. RESULTS: The patients included 22 women and 50 men of overall average age 47.1 ± 7.8 years. The prevalences of No/Mild (group I) and Moderate/Severe (group II) dysphagia were 69.4% (50 patients) and 30.6% (22 patients), respectively. Mean preoperative NDI, NPDS, PCS, and MCS scores of 34.2, 44.8, 33.7, and 46.2 in the 72 study subject improved to 9.9, 16.1, 55.1, and 56.2, respectively, at 1 year after surgery. The mean preoperative ZDS and ZAS scores were 35.2 and 34.2, respectively. The two study groups were significantly different in terms of the presence of a psychiatric problem, preoperative NDIs, and MCS scores. However, multivariate logistic regression showed that the presence of a psychiatric problem prior to surgery (P = 0.005) was the only significant predictor of chronic dysphagia. CONCLUSIONS: The presence of a psychiatric problem seems to be an important risk factor of chronic dysphagia in patients with cervical disc herniation. The study shows that psychiatric factors should be evaluated prior to surgery to determine the risk of chronic dysphagia.

Correlation between clinical outcomes and spinopelvic parameters in osteoporosis.

INTRODUCTION: Little data is available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in osteoporotic patients. The aim of this study was to identify relationships between spinopelvic parameters and HRQOL in osteoporosis. MATERIAL AND METHODS: The patient and control groups comprised 138 osteoporotic patients and 40 controls. All underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were; sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Lumbar spinal bone mineral density (LSBMD) and femoral neck BMD (FNBMD) of the non-dominant proximal femur were measured. A Visual Analogue Scale (VAS: 0-10) was used to assess back pain, and the Oswestry disability index (ODI) questionnaire and the Scoliosis Research Society (SRS-22) questionnaire to evaluate QOL. Statistical analysis was performed to identify significant differences between the patient and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. RESULTS: Patients and controls were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant intergroup difference was observed for pelvic incidence (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis, sacral slope, and FNBMD significantly predicted VAS, ODI, and SRS-22 scores and that LSBMD predicted SRS-22 scores. CONCLUSIONS: Osteoporotic patients and controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcome variables. In particular, sagittal vertical axis, sacral slope, and FNBMD significantly predicted clinical outcomes in osteoporotic patients.

Nonunion of the radial neck following operative treatment for displaced radial head and neck fractures.

Nonunion of the radial neck is uncommon after operative treatment of displaced radial head and neck fractures. Treatment of nonunion of the radial neck remains a subject of debate and various treatment options have been introduced. This study presents six patients with nonunion of the radial neck following operative treatment for displaced radial head and neck fractures and the long-term clinical outcomes of conservative treatment for nonunion of the radial neck. Three hundred and twenty-six patients underwent operative treatment for displaced fractures of the radial head and neck from 1996 to 2008; six of these patients (1.8%) developed nonunion of the radial neck. No additional surgical treatment was undertaken after nonunion was confirmed. Time from primary operation to diagnosis of nonunion, clinical presentation, radial head-shaft angle, range of motion and residual angulations on plain radiographs were documented. Functional outcomes were evaluated using the Mayo elbow performance index (MEPI) at final follow-up visit. Average time from primary operation to diagnosis of nonunion was 10.2 months. Five patients reported no functional deficits and no clinical discomfort when nonunions were confirmed. Another patient complained of mild elbow discomfort only when lifting heavy weights. All patients achieved satisfactory clinical outcomes after an average follow-up of 7.6 years. Regardless of radiological findings, no further surgical treatment is recommended for asymptomatic nonunion of the neck of the radius.

A Long-Term Follow-up, Multicenter, Comparative Study of the Radiologic, and Clinical Results Between a CaO-SiO2-P2O5-B2O3 Bioactive Glass Ceramics (BGS-7) Intervertebral Spacer and Titanium Cage in 1-Level Posterior Lumbar Interbody Fusion.

STUDY DESIGN: This is a prospective, stratified randomized, multicenter, 4-year follow-up study. OBJECTIVE: The authors aimed to evaluate the long-term clinical efficacy and safety of CaO-SiO2-P2O5-B2O3 glass ceramics (BGS-7) spacers in 1-level posterior lumbar interbody fusion (PLIF) at a 4-year follow-up. SUMMARY OF BACKGROUND DATA: According to 1-year follow-up results, BGS-7 spacer showed similar fusion rates and clinical outcomes compared with titanium cage. A long-term follow-up study beyond 2 years is necessary to investigate the status of intervertebral bone graft volumes. Moreover, longer follow-up is mandatory to also evaluate the safety and efficacy of BGS-7 spacers, because they remain in the intervertebral space for a long time. MATERIALS AND METHODS: In this prospective, randomized, multicenter, 4-year follow-up study, we evaluated 62 of the 74 patients who underwent 1-level PLIF. During 1-level PLIF, titanium cages filled with autologous local bone were inserted into the control group patients and BGS-7 spacers were inserted to the experimental group patients. Bone fusion was evaluated by plain radiography and thin-section computed tomography. Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), Short Form-36 Health Survey (SF-36), and evaluation of safety were conducted after 48 months. RESULTS: Computed tomography scan showed a bone fusion rate of 90.6% in the BGS-7 spacer group and 93.3% in the control group, with no significant differences between groups. The BGS-7 spacer group showed a significantly larger area directly fused to the endplate than the control group (P<0.001). The BGS-7 spacer group showed a significant increase in the fused area compared with the titanium group at 1- and 4-year follow-up. The ODI, SF-36, back pain, and lower limb pain in both groups showed significant improvement after surgery, and no significant differences were observed between the groups. Both groups showed no additional adverse events. CONCLUSIONS: The 4-year follow-up study showed similar fusion rates and clinical outcomes in both the BGS-7 spacer and autologous bone with a titanium cage in 1-level PLIF. However, the BGS-7 spacer implants showed a larger area of fusion with the endplates than that of autologous bone with a titanium cage. Therefore, the results demonstrated that the BGS-7 spacer can be considered as a novel intervertebral spacer to achieve successful spinal fusion without safety concerns for long-term use.

Traumatic C1-2 posterolateral dislocation with dens fracture, injury of the transverse atlantal ligament, and unilateral facet fracture with subluxation of C6-7: A case report.

RATIONALE: Traumatic C1-2 dislocation associated with contiguous or noncontiguous cervical spine injury is rare. Moreover, there have been no reports describing traumatic C1-2 dislocation associated with multiple contiguous and noncontiguous cervical injuries. PATIENT CONCERNS: The authors present a case of a 20-year-old male with painful limitation of motion of the neck. This complex cervical injury occurred due to hyperextension of the head in a rotated position. The patient complained of neck pain that radiated to the left shoulder and arm, but he did not exhibit any neurological abnormalities. DIAGNOSES: The diagnosis of the patients was traumatic C1-2 posterolateral dislocation associated with type II dens fracture (Anderson and D'Alonzo classification), type II injury of the transverse atlantal ligament (Dickman classification), and unilateral facet fracture with subluxation of C6-7. INTERVENTIONS: The C1-2 posterolateral dislocation with type II dens fracture was successfully reduced by skull traction. The patient underwent anterior discectomy, open reduction, and fusion with plate fixation of C6-7 followed by posterior segmental fixation and fusion of C1-2. OUTCOMES: At his postoperative 1-year follow-up, solid fusion was noted with improvement of clinical symptoms. This is the first report of traumatic C1-2 posterolateral dislocation associated with multiple C2 injuries and noncontiguous subaxial cervical injury. LESSONS: A high index of suspicion and careful evaluation of entire cervical spine should be considered as the key to the proper diagnosis and treatment of traumatic C1-2 dislocation associated with contiguous and noncontiguous cervical injuries.

Glomangiopericytoma of the Spinal Cord.

Glomangiopericytoma, also referred to as a hemangiopericytoma-like tumor or sinonasal type hemangiopericytoma, is a rare tumor of the nasal cavity and paranasal sinus that has never been reported in the spinal cord. Here, we report a case of a 47-year-old man who developed glomangiopericytoma in the thoracic spine. This lesion showed a heterogeneous high signal intensity compared to the spinal cord on a T2-weighted image and an easily enhanced isointense signal on a T1-weighted image.

Relationships among Disability, Quality of Life, and Physical Fitness in Lumbar Spinal Stenosis: An Investigation of Elderly Korean Women.

STUDY DESIGN: A cross-sectional, case-control study. PURPOSE: To investigate associations between physical fitness measures and disabilities related to back pain and quality of life (QOL) by the presence of symptomatic lumbar spinal stenosis (LSS) in elderly Korean women. OVERVIEW OF LITERATURE: LSS leads to decreased functioning and reduced QOL. However, correlations among physical fitness, disability, and QOL have not been investigated in elderly women with LSS. METHODS: Participants included women aged 65 years and older (n=192), divided into a study group (n=38) and a control group (n=154) based on the presence/absence of LSS. All participants underwent physical function and fitness tests. Oswestry disability index (ODI) scores and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were used to assess disability and health-related QOL. RESULTS: The results for the handgrip strength, sit-and-reach, functional reach, and timed up and go (TUG) tests were significantly higher in the control group than the LSS group. ODI scores were significantly higher and EQ-5D-5L scores significantly lower in the LSS group. TUG and functional reach test scores were significantly correlated with ODI scores, and handgrip strength was strongly interrelated with ODI and EQ-5D-5L scores in the LSS group. No other physical fitness measures showed statistically significant relationships with ODI or EQ-5D-5L scores. CONCLUSIONS: In elderly Korean women with LSS, back pain-related disability and QOL are significantly associated with some physical fitness parameters such as handgrip strength. Handgrip strength reflects general muscle strength, which is significantly interrelated with the level of disability and QOL. Our results suggest that enhancing generalized muscle strength helps to reduce disability due to back pain and improve QOL in patients with LSS.

The Reliabilities of Radiographic Measurements of Cervical Sagittal Alignment in Ankylosing Spondylitis.

STUDY DESIGN: This is a prospective study design. OBJECTIVE: To test the interobserver and intraobserver reliabilities of 5 specific measures of global cervical sagittal alignment in patients with ankylosing spondylitis (AS), and to suggest a better means of measuring cervical sagittal alignment. SUMMARY OF BACKGROUND DATA: The intraobserver and interobserver reliabilities of several different methods of measuring cervical lordosis have been reported. However, they have not been studied till yet in patients with AS. METHODS: Interobserver and intraobserver reliabilities of 5 specific measures of cervical lordosis were evaluated in patients with AS. Eighty patients with AS were allocated to a nonankylosis or an ankylosis group, and the reliabilities of the Cobb C1-C7, Cobb C2-C7, centroid, posterior tangent, and Ishihara index methods were evaluated. RESULTS: The intraclass and interclass correlation coefficients (ICCs) of all 5 methods were generally high. For the 80 study subjects, ICCs were ≥0.84 (excellent) for all 5 radiographic methods. However, comparison of the ICCs, 95% confidence intervals, and mean absolute differences (MAD) between groups with varying degrees of ankylosis showed that the reliability of lordosis measurements decreased as the severity of ankylosis increased. The 5 methods consistently demonstrated higher ICCs for both interobserver and intraobserver comparisons in the nonankylosis group. However, in the ankylosis group, the Cobb C1-C7 method demonstrated high ICCs for both interobserver and intraobserver comparisons, whereas the other 4 methods had high ICCs only for intraobserver comparisons. The intraobserver MADs were similar for the 5 methods (2.4-3.9), but the interobserver MADs of measurement methods in both groups showed low measurement reliability except for the Cobb C1-C7 methods. CONCLUSIONS: This study provides a reliability analysis of different cervical lordosis measurement methods in AS, and shows that the Cobb C1-C7 method provides a reliable means for measuring cervical lordosis in AS.

Incidence of Dysphagia and Serial Videofluoroscopic Swallow Study Findings After Anterior Cervical Discectomy and Fusion: A Prospective Study.

STUDY DESIGN: Prospective study. OBJECTIVE: To prospectively assess the incidence of dysphagia and to present the serial changes of each finding in the videofluoroscopic swallow study (VFSS) after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: The reported incidence of dysphagia after ACDF has varied widely, and the serial changes of dysphagia using VFSS have not been clearly determined yet. METHODS: Data of 47 patients preoperatively and at 1 week and 1 month postoperatively were used for the analyses. The Bazaz dysphagia score and VFSS were checked preoperatively and at 1 week and 1 month postoperatively. The presence of aspiration or penetration, amount of vallecular and pyriform sinus residues, functional dysphagia scale, temporal parameters of oral transit time, pharyngeal transit time, and pharyngeal delay time (PDT) were evaluated from the VFSS data. RESULTS: Incidences of dysphagia measured by the Bazaz dysphagia score were 83.0% at 1 week and 59.6% at 1 month after ACDF. Although the incidence of aspiration was 4.3% and the incidence of penetration was 36.2% at 1 week and 25.5% at 1 month after surgery, none of the patients had aspiration pneumonia. The number of patients with vallecular and pyriform sinus residues significantly increased after ACDF. Further, there were no statistically significant changes at all time points in terms of oral transit time, pharyngeal transit time, and pharyngeal delay time. CONCLUSIONS: Dysphagia is common until 1 month after ACDF. Although the incidence of aspiration or penetration in VFSS after ACDF was high, no patient had aspiration pneumonia, which may be because of the intact neurological swallowing mechanism. The typical pattern of dysphagia after ACDF included vallecular and pyriform sinuses filled with postswallow residue, which may result from soft tissue edema and weak constriction of pharyngeal muscles after ACDF.

Distraction Arthrodesis of the C1-C2 Facet Joint with Preservation of the C2 Root for the Management of Intractable Occipital Neuralgia Caused by C2 Root Compression.

STUDY DESIGN: Prospective observational cohort study. OBJECTIVE: To compare the outcomes of our new technique, distraction arthrodesis of C1-C2 facet joint with C2 root preservation (Study group), to those of conventional C1-C2 fusion with C2 root transection (Control group) for the management of intractable occipital neuralgia caused by C2 root compression. SUMMARY OF BACKGROUND DATA: We are not aware of any report concerning C2 root decompression during C1-C2 fusion. MATERIALS AND METHODS: Inclusion criteria were visual analogue scale (VAS) score for occipital neuralgia 7 or more; C2 root compression at the collapsed C1-C2 neural foramen; and follow-up 12 months or more. The Study group underwent surgery with our new technique including (1) C1-C2 facet joint distraction and bone block insertion while preserving the C2 root; and (2) use of C1 posterior arch screws instead of conventional lateral mass screws during C1-C2 segmental screw fixation. The Control group underwent C2 root transection with C1-C2 segmental screw fixation and fusion. We compared the prospectively collected outcomes data. RESULTS: There were 15 patients in the Study group and 8 in the Control group. Although there was no significant difference in the VAS score for the occipital neuralgia between the 2 groups preoperatively (8.2 ± 0.9 vs. 7.9 ± 0.6, P = 0.39), it was significantly lower in the Study group at 1, 3, and 6 months postoperatively (P < 0.01, respectively). At 12 months, it was 0.4 ± 0.6 versus 2.5 ± 2.6 (P = 0.01). There was no significant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally influenced by occipital neuralgia. CONCLUSION: Our novel technique of distraction arthrodesis with C2 root preservation can be an effective option for the management of intractable occipital neuralgia caused by C2 root compression.

Influence of pain sensitivity on surgical outcomes after lumbar spine surgery in patients with lumbar spinal stenosis.

STUDY DESIGN: Prospective observational study. OBJECTIVE: To assess the influence of pain sensitivity on surgical outcomes after lumbar spine surgery in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: No previous study has investigated the relationship between the surgical outcomes for LSS and pain sensitivity questionnaire (PSQ) scores. METHODS: The study included 171 patients who were scheduled to undergo spine surgery for LSS. On the basis of their PSQ scores, patients were assigned to either a low (PSQ score<6.5, n=87) or high PSQ group (PSQ score≥6.5, n=84). The primary outcome was the Oswestry Disability Index (ODI) at 12 months after surgery. RESULTS: The ODI at 12 months after surgery was significantly lower in the low PSQ group than in the high PSQ group. Twelve months after surgery, the mean ODI scores (95% confidence interval) in the low and high PSQ groups were 21.1 (16.8-25.5) and 29.6 (25.0-34.1), respectively. The difference (95% confidence interval) in the ODI between the 2 groups was 3.2 (-14.7 to -2.2) (P=0.009). There were significant differences in the secondary endpoints, including the ODI and visual analogue scale (VAS) scores for back and leg pain, in the follow-up assessments during a 12-month period after surgery, between the 2 groups (PSQ group; P<0.001 for the ODI, VAS score for back pain, and VAS score for leg pain). However, the patterns of changes of the ODI and VAS scores for back pain and leg pain in the follow-up assessments during a 12-month period were not significantly different (interaction between the PSQ group and follow-up assessment time; P=0.757, 0.126, and 0.950, respectively). CONCLUSION: Patients with high pain sensitivity may display less improvement in back pain, leg pain, and disability after surgery for LSS compared with patients with low pain sensitivity. Furthermore, the PSQ can be used to predict surgical outcomes after spine surgery for LSS. LEVEL OF EVIDENCE: 2.

Determination of the Optimal Cutoff Values for Pain Sensitivity Questionnaire Scores and the Oswestry Disability Index for Favorable Surgical Outcomes in Subjects With Lumbar Spinal Stenosis.

STUDY DESIGN: Retrospective analysis of prospectively collected data (NCT02134821). OBJECTIVE: The aim of this study was to elucidate the cutoff values for significant predictors for favorable outcomes after lumbar spine surgery in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Various factors are associated with the surgical outcomes for patients with LSS. However, we did not know the odds ratio and/or cutoff values of a predictive factor for a favorable surgical outcome for LSS. METHODS: A total of 157 patients who underwent spine surgery due to LSS between June 2012 and April 2013 were included in this study. The patients were dichotomized into 2 groups on the basis of an Oswestry Disability Index (ODI) score of 22 or less (favorable outcome group) or more than 22 (unfavorable outcome group) at 12 months after surgery. Regarding favorable outcomes, the odds ratio for each preoperative variable including demographic data, preoperative symptom severity, and pain sensitivity questionnaire (PSQ) score was calculated using univariate and multivariate logistic regression analyses. For the significant variables for surgical outcome, receiver operating characteristic (ROC) curve was plotted with calculation of the area under the ROC curve. RESULTS: Multivariate analysis revealed that the ODI and total PSQ scores were significantly associated with a greater likelihood of an unfavorable surgical outcome [odds ratio (95% confidence interval) of ODI, 1.289 (1.028-1.616); odds ratio (95% confidence interval) of total PSQ, 1.060 (1.009-1.113)]. ROC analysis revealed area under the ROC curves for the total PSQ and ODI scores of 0.638 (P = 0.005) and 0.692 (P < 0.001), respectively. CONCLUSION: Preoperative disability and pain sensitivity can be predictors of the functional level achieved after spine surgery in patients with LSS, and the ideal cutoff values for the total PSQ and ODI scores were 6.6 and 45.0, respectively.

Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Retrospective fusion level(s)-, age-, and gender-matched analysis. PURPOSE: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. OVERVIEW OF LITERATURE: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. METHODS: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. RESULTS: The total drain amount for the first 24 hours (8±9 versus 27±22 mL), total drain amount until the 8-hour drainage decreased to ≤10 mL (8±10 versus 33±26 mL), and the total drain amount until 6 AM on the first postoperative day (7±8 versus 24±20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to ≤10 mL was significantly lower in the study group (10±5 versus 26±14 hours, p<0.001). The 8-hour drainage decreased to ≤10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. CONCLUSIONS: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.

Myositis ossificans of the elbow after a trigger point injection.

Trigger point injection is a simple procedure that is widely performed for relieving pain. Even though there are several complications of trigger point injection, myositis ossificans has not been documented as one of its complications. We treated a patient who suffered from painful limitation of elbow motion and this was caused by myositis ossificans between the insertions of brachialis and supinator muscles after a trigger point injection containing lidocaine mixed with saline, and we also review the relevant medical literature.