Effect of COVID-19 on quality of life of persons aged >70 years with adult spinal deformity: A cross-sectional case-control study.

This observational, cross-sectional case-control study evaluates the impact of coronavirus disease 2019 (COVID-19) on health-related quality of life (HRQoL) in elderly persons who have undergone surgery for adult spinal deformity (ASD). On December 31, 2019, the Chinese authorities first reported severe acute respiratory syndrome coronavirus 2, and on March 11, 2020, it was declared a pandemic. The pandemic seems to have had a negative effect on elderly patients who underwent ASD, in terms of functional and psychological quality of life. We selected patients with ASD aged > 70 years who had undergone surgery between 2010 and 2015 and compared them with age- and sex-matched patients who did not have ASD. We recorded sociodemographic variables, type of surgery, levels of spinal fusion, HRQoL (Scoliosis Research Society-22, Short Form 12 Health Survey, EuroQol-5D [EQ-5], Geriatric Depression Scale [Yesavage] [GDS], Modified Frailty Index-11, and Barthel index), fear of visiting a health center, fear of leaving one's house, and adherence to preventive measures. The study population comprised 174 patients (mean [standard deviation] age, 77.3 [5.9] years; 86% women), of whom 87 had undergone surgery for ASD. The incidence of COVID-19 was higher in patients aged > 85 years (P = .041), urban areas (P = .047), and in patients in long-term care (P = .03). Similarly, no differences were observed for the ability to cope with the pandemic (P > .05). Patients who underwent surgery also had a higher risk of depression (GDS, 6.7 [P = .02]), a lower EQ-5 score (P = .001), a higher body mass index (P = .004), greater consumption of drugs (P < .001), especially opiates (P < .001). Patients who underwent surgery constitute a vulnerable population during the COVID-19 pandemic, with poorer quality of life and had a much higher risk of depression. They are also polymedicated and prefrail, adhere well to COVID-19 preventive measures, and do not seem to fear visiting health centers.

Utilización de un nuevo tornillo expansivo en pacientes con mala calidad ósea: estudio multicéntrico / Utilização de um novo parafuso expansivo em pacientes com má qualidade óssea: estudo multicêntrico / Use of a new expansive screw in patients with poor bone quality: multicenter study

OBJETIVO: Observar el comportamiento del tornillo expansivo en pacientes con mala calidad ósea, su seguridad, técnica, manejo y complicaciones: porcentaje de aflojamiento, roturas, "pull-out" y pseudartrosis. MÉTODOS: Realizamos estudio prospectivo multicéntrico analizando factores de riesgo del paciente, VAS, tiempo quirúrgico, pérdida de sangre, emplazamiento de tornillos y complicaciones debidas al implante a la alta y a los 3, 12 y 24 meses. RESULTADOS: El 99% de los pacientes no tuvieron ninguna complicación permanente relacionada con el implante; sólo hubo un caso de radiculopatía no resuelta. En el 95% de los implantes, los tornillos se colocaron sin complicaciones; en el 5% aparecieron complicaciones relacionadas con la mala colocación o expansión del tornillo, resueltas en acto quirúrgico. Tiempo quirúrgico promedio por nivel, 56 min.; tiempo promedio por intervención, 2 horas 35 min. Sangramiento promedio por nivel intervenido, 211cc. Hemos tenido tres casos de "pull-out". El VAS evolucionó favorablemente de forma significativa, con reducciones promedio mayores a cuatro puntos. El estudio continuará hasta los cinco años, siendo estos los resultados preliminares. CONCLUSIONES: Este tipo de tornillos expansivos aportan un nuevo sistema de anclaje para pacientes con mala calidad ósea; son seguros y eficaces, ofrecen rapidez en su colocación, una menor exposición a los RXy, en caso de retirada del tornillo, dejan el camino libre para una nueva cirugía.

OBJETIVO: Observar o comportamento do parafuso expansivo em pacientes com má qualidade óssea, sua segurança, a técnica, conduta e complicações: porcentagem de afrouxamento, quebras, "pull-out" e pseudoartrose. MÉTODOS: Estudo prospectivo multicêntrico analisando fatores de risco do paciente, VAS, tempo cirúrgico, perda de sangue, localização dos parafusos e complicações devido ao implante na alta e aos 3, 12 e 24 meses. RESULTADOS: 99% dos pacientes não tiveram nenhuma complicação permanente relacionada com o implante; apenas um caso de radiculopatia não se resolveu. Em 95% dos implantes, os parafusos foram colocados sem complicações; em 5% houve complicações relacionadas com a má colocação ou expansão do parafuso, que foram resolvidas com cirurgia. Tempo médio de cirurgia por nível, 56 min.; tempo médio por intervenção, 2 horas e 35 min. Sangramento médio por nível que recebeu intervenção, 211 cc. Ocorreram três casos de "pull-out". A VAS evoluiu favoravelmente e de forma significante, con reduções médias maiores que quatro pontos. O estudo continuará até os cinco anos, sendo que estes são os resultados preliminares. CONCLUSÕES: Esse tipo de parafuso expansivo é um novo sistema de ancoragem para pacientes com má qualidade óssea; são seguros e eficazes, rápidos para colocar, proporcionam menos exposição aos RX e, em caso de retirada do parafuso, deixam o caminho livre para uma nova cirurgia.

OBJECTIVE: To observe the behavior of the expansive screw in patients with poor bone quality, its safety, the technique, conduct and complications: percentage of loosening, breaks, pull-outs and pseudoarthrosis. METHODS: Prospective multicenter study analyzing the patient’s risk factors, VAS, surgery time, blood loss, location of the screws and complications due to the implant at the time of discharge, and at 3, 12 and 24 months. RESULTS: 99% of the patients did not have any permanent complications related to the implant; there was only one case of unresolved radiculopathy. In 95% of the implants, the screws were placed without complications; in 5% percent of cases there were complications related to poor placement or expansion of the screw, which were resolved with the surgery. Mean intervention time per level: 56 minutes; average intervention time, 2 hours and 35 min. Average bleeding per level that received intervention, 211cc. There were three cases of "pull-out". VAS evolved favorably and significantly, with average reduction greater than four points. The study will continue until age five, these being the preliminary results. CONCLUSIONS: This type of expansive screw provides a new anchoring system for patients with poor bone quality; it is safe and effective, easy to insert, and provides less exposure to X-ray, and in case of removal of the screw, it leaves the way free for a new surgery.