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1.
Gastrointest Endosc Clin N Am ; 34(4): 609-626, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39277294

RESUMEN

Bariatric surgery has evolved and gained in popularity as it has been recognized as the most sustainable and effective treatment for obesity and related diseases. These related diseases are significant causes of obesity related morbidity and mortality. Most bariatric procedures incorporate some component of gastric restriction with or without intestinal bypass, but the full mechanism of these procedures has yet to be elucidated. The most popular surgical procedure remains the sleeve gastrectomy over the last 10 years, while gastric bypass is also still commonly performed. We have also seen growth in revisional bariatric surgery and novel surgical procedures.


Asunto(s)
Cirugía Bariátrica , Humanos , Cirugía Bariátrica/tendencias , Cirugía Bariátrica/métodos , Gastrectomía/métodos , Gastrectomía/tendencias , Obesidad Mórbida/cirugía , Obesidad/cirugía , Derivación Gástrica/métodos , Derivación Gástrica/tendencias , Reoperación/tendencias , Reoperación/estadística & datos numéricos
2.
J Binocul Vis Ocul Motil ; 74(2): 84-90, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38924773

RESUMEN

PURPOSE: To analyze characteristics and trends of strabismus surgeries in an Israeli hospital over 2 decades. METHODS: A descriptive, retrospective study including all strabismus surgeries (666) performed during 2000-2019 at an Israeli tertiary hospital. Electronic medical records (EMRs) were directly retrieved to produce an anonymized database. RESULTS: No trends were evident for age, sex, or ethnicity (p = .294, 0.914 and p = .167, respectively). The mean number of horizontal muscles remained stable, while an increase was noted in the mean number of muscles operated on to repair vertical strabismus (p < .0001). Among acquired cases, a 2.67-fold increase was noted in the proportion of spontaneous strabismus and a decrease of traumatic causes to a third (p < .001). An increase was noted in the proportion of exotropia among horizontal strabismus corrections (p = .022), and esotropia correction techniques distribution changed (p = .004). Reoperations comprised a third of all cases during both decades (p = .198). Reoperations were more prevalent among younger and Jewish patients (p < .001 and p = .024, respectively). Techniques to correct esotropia and exotropia differed significantly between primary surgeries and reoperations (p < .00001 each). CONCLUSIONS: The complexity of surgical techniques increased over time. Ethnic minorities were less prone to reoperations.


Asunto(s)
Músculos Oculomotores , Procedimientos Quirúrgicos Oftalmológicos , Estrabismo , Centros de Atención Terciaria , Humanos , Centros de Atención Terciaria/estadística & datos numéricos , Centros de Atención Terciaria/tendencias , Masculino , Estudios Retrospectivos , Femenino , Estrabismo/cirugía , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/tendencias , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Niño , Adulto , Adolescente , Persona de Mediana Edad , Preescolar , Israel/epidemiología , Reoperación/estadística & datos numéricos , Reoperación/tendencias , Adulto Joven , Anciano , Lactante , Anciano de 80 o más Años
3.
J Arthroplasty ; 39(8): 1906-1910.e1, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38220026

RESUMEN

BACKGROUND: In patients considered high-risk for infection, extended oral antibiotic (EOA) prophylaxis has been demonstrated to reduce rates of prosthetic joint infection following total hip arthroplasty (THA). Although national guidelines regarding their use have not yet been created, the increase in literature surrounding EOA prophylaxis suggests a potential change in practice patterns. The purpose of this study was to investigate the trends in utilization of EOA prophylaxis following THA from 2010 to 2022 and identify prescription patterns. METHODS: A total of 646,059 primary THA and 51,879 aseptic revision THA patients were included in this study. Patients who underwent primary or aseptic revision THA between 2010 and 2022 were identified in a national administrative claims database. Rates and duration of EOA prescriptions were calculated. A secondary analysis examined rates of utilization across demographics, including patients considered high risk for infection. RESULTS: From 2010 to 2022, utilization of EOA increased by 366% and 298% following primary and revision THA, respectively. Of patients prescribed postoperative antibiotics, 30% and 59% were prescribed antibiotics for more than 7 days following primary and revision THA, respectively. Rates of utilization were similar between high-risk individuals and the general population. CONCLUSIONS: Rates of utilization of EOA prophylaxis after THA have increased significantly since 2010. As current trends demonstrate a wide variation in prescription patterns, including in length of antibiotic duration and in patient population prescribed, guidelines surrounding the use of EOA prophylaxis after THA are necessary to promote antibiotic stewardship while preventing rates of periprosthetic joint infection.


Asunto(s)
Antibacterianos , Profilaxis Antibiótica , Artroplastia de Reemplazo de Cadera , Infecciones Relacionadas con Prótesis , Reoperación , Humanos , Artroplastia de Reemplazo de Cadera/tendencias , Artroplastia de Reemplazo de Cadera/efectos adversos , Profilaxis Antibiótica/tendencias , Profilaxis Antibiótica/estadística & datos numéricos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Infecciones Relacionadas con Prótesis/prevención & control , Reoperación/estadística & datos numéricos , Reoperación/tendencias , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Administración Oral , Pautas de la Práctica en Medicina/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Estudios Retrospectivos
4.
Medicine (Baltimore) ; 100(41): e27515, 2021 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-34731139

RESUMEN

ABSTRACT: Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.


Asunto(s)
Pérdida de Líquido Cefalorraquídeo/epidemiología , Asociaciones de Práctica Independiente/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Columna Vertebral/cirugía , Cirujanos/estadística & datos numéricos , Adulto , Anciano , Canadá/epidemiología , Vértebras Cervicales/cirugía , Competencia Clínica/estadística & datos numéricos , Descompresión Quirúrgica/métodos , Discectomía/métodos , Discectomía/tendencias , Femenino , Humanos , Asociaciones de Práctica Independiente/tendencias , Laminectomía/métodos , Curva de Aprendizaje , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Reoperación/tendencias , Estudios Retrospectivos , Población Rural , Fusión Vertebral/métodos
5.
Sci Rep ; 11(1): 15479, 2021 07 29.
Artículo en Inglés | MEDLINE | ID: mdl-34326421

RESUMEN

We aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee PJI? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). In 2018, a total number 23,812 revision knee arthroplasties were performed in Germany, yielding an overall increase of 20.76% between 2008 and 2018. In comparison, primary TKA procedures increased by 23.8% from 152,551 performed procedures in 2008 to 188,866 procedures in 2018. Hence, 12.6% of knee arthroplasties required a revision in 2018. Septic interventions increased by 51.7% for all revisions. A trend towards higher numbers in younger patients was observed. Compared to 2008, 17.41% less DAIR procedures were performed, whereby single-stage and two- or multi-stage change increased by 38.76% and 42.76% in 2018, respectively. The increasing number of revision knee arthroplasty in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies to delay primary arthroplasty and avoid periprosthetic joint infection.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/tendencias , Prótesis de la Rodilla , Reoperación/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Rodilla/métodos , Desbridamiento , Femenino , Alemania/epidemiología , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Reoperación/métodos , Adulto Joven
6.
J Bone Joint Surg Am ; 103(14): 1335-1354, 2021 07 21.
Artículo en Inglés | MEDLINE | ID: mdl-34260441

RESUMEN

BACKGROUND: An overall assessment of how patient demographic characteristics and comorbidities are improving or worsening can allow better understanding of the value of revision total joint arthroplasty (TJA). Therefore, the purpose of this study was to identify patient demographic characteristics and comorbidities trends and episode-of-care outcome trends from 2008 to 2018 in patients undergoing revision TJA. METHODS: The National Surgical Quality Improvement Program database was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients undergoing revision TJA from 2008 to 2018 (n = 45,706). Pairwise t tests and pairwise chi-square tests were performed on consecutive years with Bonferroni correction. Trends were assessed using the 2-tailed Mann-Kendall test of the temporal trend. RESULTS: Among patients undergoing revision TJA, there was no clinically important difference, from 2008 to 2018, in age, body mass index (BMI), percentages with >40 kg/m2 BMI, diabetes (18.8% to 19%), chronic obstructive pulmonary disease (4.1% to 5.4%), congestive heart failure within 30 days (0% to 1%), or acute renal failure (0% to 0.2%). However, modifiable comorbidities including smoking status (14.7% to 12.0%; p = 0.01), hypertension (66% to 26.0%; p = 0.02), anemia (34.5% to 26.3%; p < 0.001), malnutrition (10.4% to 9.3%; p = 0.004), and overall morbidity or mortality probability have improved, with a decrease in the hospital length of stay and 30-day readmission and a significant increase in home discharge (p < 0.001 for all). CONCLUSIONS: Time-difference analysis demonstrated that the overall health status of patients undergoing revision TJA improved from 2008 to 2018. However, formal time-trend analysis demonstrated improvements to a lesser degree. The multidisciplinary effort to improve value-based metrics including patient comorbidity optimization and episode-of-care outcomes for primary TJA has been shown to potentially have an impact on revision TJA. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Complicaciones Posoperatorias/epidemiología , Brechas de la Práctica Profesional/estadística & datos numéricos , Reoperación/tendencias , Anciano , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/tendencias , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/tendencias , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/tendencias , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/tendencias , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Mejoramiento de la Calidad , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
7.
J Clin Neurosci ; 89: 128-132, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34119255

RESUMEN

Most existing anterior cervical discectomy and fusion (ACDF) outcome studies omit emergency department (ED) use. To our knowledge, this study on ED use following ACDF surgery is the first to use a direct patient chart review and the first to include revision patients, 1-5 levels of ACDFs, and performance of corpectomy in the analysis. This study examines the frequency and basis of hospital service use within 30 days of ACDF surgery, specifically ED visits, hospital readmissions, and returns to the operating room. A retrospective chart review was performed for 1273 consecutive patients who underwent ACDF surgery at one institution from July 2013 to June 2016. Of the 1273 patients with ACDF, 97 (7.6%) presented to the ED within 30 days after surgery. Of 43 patients with revision ACDF, 9 (20.9%) returned to the ED, compared with 88 (7.2%) of 1230 patients with primary ACDF (P = 0.001). Of the 111 ED visits by 97 patients, 40 (36%) were for cervicalgia, 13 (12%) were for dysphagia, 8 (7%) were for trauma, 7 (6%) were for nausea, 4 (4%) were for medication refill, 3 (3%) were for dehiscence, 3 (3%) were for pneumonia, and 3 (3%) were for urinary tract infection. Of the ED presentations, 8 (7%) occurred during the first 2 days after surgery, and 46 (41%) occurred within the first postoperative week.


Asunto(s)
Vértebras Cervicales/cirugía , Trastornos de Deglución/cirugía , Discectomía/tendencias , Servicio de Urgencia en Hospital/tendencias , Dolor de Cuello/cirugía , Readmisión del Paciente/tendencias , Fusión Vertebral/tendencias , Adulto , Anciano , Estudios de Cohortes , Trastornos de Deglución/diagnóstico , Discectomía/efectos adversos , Femenino , Hospitales/tendencias , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación/tendencias , Estudios Retrospectivos , Fusión Vertebral/efectos adversos
8.
Ann R Coll Surg Engl ; 103(7): 493-495, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192492

RESUMEN

BACKGROUND: Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. METHOD: We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15 years (2004-2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. RESULTS: In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. CONCLUSIONS: Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/tendencias , Laparoscopía/tendencias , Reoperación/tendencias , Mallas Quirúrgicas/tendencias , Registros Electrónicos de Salud/estadística & datos numéricos , Herniorrafia/instrumentación , Herniorrafia/métodos , Herniorrafia/estadística & datos numéricos , Humanos , Laparoscopía/instrumentación , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Recurrencia , Reoperación/instrumentación , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medicina Estatal/estadística & datos numéricos , Medicina Estatal/tendencias , Mallas Quirúrgicas/estadística & datos numéricos , Gales
9.
J Clin Neurosci ; 86: 193-201, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33775327

RESUMEN

BACKGROUND: Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone. METHODS: Patients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated. RESULTS: A total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.


Asunto(s)
Discectomía/métodos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Adulto , Estudios de Cohortes , Discectomía/tendencias , Femenino , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/cirugía , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dimensión del Dolor/tendencias , Estudios Prospectivos , Reoperación/métodos , Reoperación/tendencias , Fusión Vertebral/tendencias , Resultado del Tratamiento
10.
J Bone Joint Surg Am ; 103(13): 1212-1219, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-33764932

RESUMEN

BACKGROUND: Investigations into reimbursement trends for primary and revision arthroplasty procedures have demonstrated a steady decline over the past several years. Revision total hip arthroplasty (rTHA) due to infection (rTHA-I) has been associated with higher resource utilization and complexity, but long-term inflation-adjusted data have yet to be compared between rTHA-I and rTHA due to aseptic complications (rTHA-A). The present study was performed to analyze temporal reimbursement trends regarding rTHA-I procedures compared with those for rTHA-A procedures. METHODS: The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements associated with 1-stage and 2-stage rTHA-I as well as 1-stage rTHA-A procedures from 2002 to 2019. Current Procedural Terminology (CPT) codes for rTHA were grouped according to the American Academy of Orthopaedic Surgeons coding reference guide. Monetary values were adjusted for inflation using the consumer price index (U.S. Bureau of Labor Statistics; reported as 2019 U.S. dollars) and used to calculate the cumulative and average annual percent changes in reimbursement. RESULTS: Following inflation adjustment, the physician fee reimbursement for rTHA-A decreased by a mean [and standard deviation] of 27.26% ± 3.57% (from $2,209.11 in 2002 to $1,603.20 in 2019) for femoral component revision, 27.41% ± 3.57% (from $2,130.55 to $1,542.91) for acetabular component revision, and 27.50% ± 2.56% (from $2,775.53 to $2,007.61) for both-component revision. Similarly, for a 2-stage rTHA-I, the mean reimbursement declined by 18.74% ± 3.87% (from $2,063.36 in 2002 to $1,673.36 in 2019) and 24.45% ± 3.69% (from $2,328.79 to $1,755.45) for the explantation and reimplantation stages, respectively. The total decline in physician fee reimbursement for rTHA-I ($1,020.64 ± $233.72) was significantly greater than that for rTHA-A ($580.72 ± $107.22; p < 0.00001). CONCLUSIONS: Our study demonstrated a consistent devaluation of both rTHA-I and rTHA-A procedures from 2002 to 2019, with a larger deficit seen for rTHA-I. A continuation of this trend could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level. LEVEL OF EVIDENCE: Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Inflación Económica , Reembolso de Seguro de Salud/economía , Medicare/economía , Reoperación/economía , Artroplastia de Reemplazo de Cadera/tendencias , Current Procedural Terminology , Honorarios Médicos , Humanos , Infecciones/complicaciones , Infecciones/economía , Reembolso de Seguro de Salud/tendencias , Complicaciones Posoperatorias/economía , Reoperación/tendencias , Factores de Tiempo , Estados Unidos
11.
Med Sci Monit ; 27: e930760, 2021 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-33712550

RESUMEN

BACKGROUND Patients with hip joint infections in childhood often have many aftereffects of different degrees, regardless of the kind of treatment or natural course. Total hip arthroplasty is currently the most effective treatment for sequelae of childhood hip septic or tuberculous infection. This is a mid-term follow-up study of treatment results of patients who had undergone total hip arthroplasty (THA) with cementless prostheses. MATERIAL AND METHODS We retrospectively analyzed and followed 45 patients (45 hips) who underwent THA with cementless prostheses between 2010 and 2017. There were 45 patients, including 17 men and 28 women. The average age of the patients was 46 years (range, 18-67 years). All hip infections occurred in early childhood or adolescence, and the mean interval between initial infection and THA was 38.2 years (range, 15-60 years). The mean follow-up was 6.1 years (range, 2.7-9.5 years). RESULTS Two patients underwent revision surgery because of loosening of the prosthesis, and 1 patient underwent revision surgery because of a new infection with no relationship with childhood infection during the follow-up. The average Harris hip scores significantly increased from 43.1 to 86.4 (P<0.01), and the average visual analog scale significantly increased from 4.6 to 1.7 (P<0.01). The hip dysfunction and osteoarthritis outcome scores were also significantly changed (P<0.01) at the final follow-up. There were 2 cases of transient sciatic nerve palsy and intraoperative periprosthetic fractures in 3 cases. During follow-up, single revision was performed after 6 years of primary arthroplasty because of aseptic loosening in 2 cases and prosthesis infection in 1 case, which was not related to childhood pathogens. CONCLUSIONS THA for patients with sequelae of hip joint infection has a satisfactory effect that can effectively relieve joint pain and improve hip function. The recurrence rate of infection after either pyogenic infection or tuberculous is very low. The mid-term outcomes of THA in this setting were satisfactory, with high prosthesis survivorship and hip function scores.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Articulación de la Cadera/cirugía , Adulto , Experiencias Adversas de la Infancia , Anciano , China , Femenino , Estudios de Seguimiento , Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Infecciones/fisiopatología , Masculino , Persona de Mediana Edad , Falla de Prótesis/etiología , Reoperación/tendencias , Estudios Retrospectivos , Resultado del Tratamiento
12.
J Bone Joint Surg Am ; 103(7): 618-628, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33617163

RESUMEN

BACKGROUND: Revision total elbow arthroplasty (TEA) has increased, especially in young patients with high functional expectations. The objective of this study was to evaluate the long-term results of revision TEA with a single semiconstrained prosthesis. METHODS: Thirty-four revision TEAs were performed with a Coonrad/Morrey prosthesis in 32 patients; 2 patients had bilateral procedures. The mean patient age was 61 years (range, 22 to 76 years), and the revision TEA was performed at a mean time of 7.8 years (range, 1.6 to 21 years) after the primary TEA. Etiologies for revisions were humeral and ulnar aseptic loosening (n = 14), ulnar aseptic loosening (n = 8), humeral aseptic loosening (n = 6), septic arthritis (n = 4), and unstable unlinked prostheses (n = 2). Clinical and radiographic evaluations were performed with systematic preoperative infection workup and quantification of bone loss. The mean follow-up was 11.4 years (range, 2 to 21 years). RESULTS: The Mayo Elbow Performance Score (MEPS) at the last follow-up was excellent in 6 cases, good in 18 cases, fair in 8 cases, and poor in 2 cases, with a mean improvement (and standard deviation) between the preoperative values at 42.4 ± 16.1 points and the postoperative values at 81.8 ± 12 points (p < 0.001). The mean pain scores improved significantly from 6.7 ± 1.3 points preoperatively to 1.4 ± 1.4 points postoperatively (p < 0.001). The flexion-extension arc increased significantly (p = 0.02) from 74° ± 27° preoperatively to 100° ± 31° postoperatively. The total number of complications was 29 in 19 revision TEAs (56%). Twenty of the 29 complications simply required monitoring without surgical intervention. Six repeat surgical procedures were required, and 3 implant revisions (9%) were performed. CONCLUSIONS: Revision TEA with a semiconstrained prosthesis can provide good clinical results that can be maintained during follow-up. The rate of complications is high. Proper evaluation of the risk-benefit ratio is essential for each revision TEA and should be discussed with the patient. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Codo/instrumentación , Prótesis Articulares/efectos adversos , Falla de Prótesis/tendencias , Reoperación/instrumentación , Adulto , Anciano , Artroplastia de Reemplazo de Codo/efectos adversos , Artroplastia de Reemplazo de Codo/estadística & datos numéricos , Artroplastia de Reemplazo de Codo/tendencias , Articulación del Codo/fisiología , Articulación del Codo/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Rango del Movimiento Articular/fisiología , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Reoperación/tendencias , Estudios Retrospectivos , Adulto Joven
13.
Spine (Phila Pa 1976) ; 46(6): 383-390, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33620183

RESUMEN

STUDY DESIGN: Retrospective register study. OBJECTIVE: The aim of this study was to assess the incidence and trends of lumbar disc surgeries in Finland from 1997 through 2018. SUMMARY OF BACKGROUND DATA: The evidence on lumbar spine discectomy has shifted from supporting surgical treatment toward nonoperative treatment. Still, the incidence of lumbar discectomy operations increased until the 1990 s. In the United States, the incidence began to decline after a downward turn in 2008, yet recent trends from countries with public and practically free health care are not widely known. METHODS: Data for this study were obtained from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients 18 years of age or older in Finland during a 22-year period from January 1, 1997, to December 31, 2018. RESULTS: A total of 65,912 lumbar discectomy operations were performed in Finland from 1997 through 2018. The annual population-based incidence of lumbar discectomy decreased 29% during the 22-year period, from 83 per 100,000 person-years in 1997 to 58 per 100,000 person-years in 2018. In addition, the incidence of microdiscectomy increased 12%, from 41 per 100,000 person-years in 1997 to 47 per 100,000 person-years in 2018, whereas the incidence of open discectomy decreased 71%, from 41 per 100,000 person-years in 1997 to 12 per 100,000 person-years in 2018. The total reoperation rate for microendoscopic, microscopic, and open discectomy surgeries was 16.3%, 15.3%, and 14.9%, respectively. CONCLUSION: The nationwide incidence of lumbar discectomy decreased in Finland from 1997 through 2018. Additionally, the incidence of open discectomy is decreasing rapidly, whereas the incidence of microsurgical techniques is increasing.Level of Evidence: 3.


Asunto(s)
Discectomía/tendencias , Desplazamiento del Disco Intervertebral/epidemiología , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adolescente , Adulto , Bases de Datos Factuales/tendencias , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Alta del Paciente/tendencias , Reoperación/tendencias , Estudios Retrospectivos , Adulto Joven
14.
Spine (Phila Pa 1976) ; 46(9): 624-629, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33394987

RESUMEN

STUDY DESIGN: Retrospective case series. OBJECTIVE: We sought to identify risk factors associated with surgical site infection (SSI) after posterior long segment spinal fusion (PLSF). SUMMARY OF BACKGROUND DATA: Patients who undergo PLSF may be at elevated risk of SSI. Identifying factors associated with SSI in these operations can help risk stratify patients and tailor management. METHODS: We analyzed PLSFs-seven or more levels-at our institution from 2000 to 2015. Data on patients' clinical characteristics, procedural factors, and antimicrobial management were collected. Multivariable analysis identified factors independently associated with outcomes of interest. RESULTS: In 628 cases, SSI was associated with steroid use (P = 0.024, odds ratio [OR] = 2.54) and using cefazolin (P < 0.001, OR = 4.37) or bacitracin (P = 0.010, OR 3.49) irrigation, as opposed to gentamicin or other irrigation. Gram-positive infections were more likely with staged procedures (P = 0.021, OR 4.91) and bacitracin irrigation (P < 0.001, OR = 17.98), and less likely with vancomycin powder (P = 0.050, OR 0.20). Gram-negative infections were more likely with a history of peripheral arterial disease (P = 0.034, OR = 3.21) or cefazolin irrigation (P < 0.001, OR 25.47). Readmission was more likely after staged procedures (P = 0.003, OR = 3.31), cervical spine surgery (P = 0.023, OR = 2.28), or cefazolin irrigation (P = 0.039, OR = 1.85). Reoperation was more common with more comorbidities (P = 0.022, OR 1.09), staged procedures (P < 0.001, OR = 4.72), cervical surgeries (P = 0.013, OR = 2.36), more participants in the surgery (P = 0.011, OR = 1.06), using cefazolin (P < 0.001, OR = 3.12) or bacitracin (P = 0.009, OR = 3.15) irrigation, and higher erythrocyte sedimentation rate at readmission (P = 0.009, OR = 1.04). Washouts were more likely among patients with more comorbidities (P = 0.013, OR = 1.16), or who used steroids (P = 0.022, OR = 2.92), and less likely after cervical surgery (P = 0.028, OR = 0.24). Instrumentation removal was more common with bacitracin irrigation (p = 0.013, OR = 31.76). CONCLUSION: Patient factors, whether a procedure is staged, and choice of antibiotic irrigation affect the risk of SSI and ensuing management required.Level of Evidence: 4.


Asunto(s)
Readmisión del Paciente/tendencias , Reoperación/tendencias , Fusión Vertebral/efectos adversos , Fusión Vertebral/tendencias , Infección de la Herida Quirúrgica/etiología , Adulto , Anciano , Antibacterianos/uso terapéutico , Cefazolina/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Vancomicina/uso terapéutico
15.
Circulation ; 143(2): 104-116, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-32975133

RESUMEN

BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.


Asunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/normas , Válvula Mitral/cirugía , Sistema de Registros , Reoperación/normas , Reemplazo de la Válvula Aórtica Transcatéter/normas , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Prótesis Valvulares Cardíacas/tendencias , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Reoperación/tendencias , Estudios Retrospectivos , Reemplazo de la Válvula Aórtica Transcatéter/tendencias
16.
Neurosurg Rev ; 44(2): 935-944, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32086690

RESUMEN

Although endovascular or surgical treatment has been performed for preventing the rupture of saccular cerebral aneurysms (sCA), in some patients, the aneurysms may recur and require retreatment. We aimed to investigate the clinical and radiological outcomes of treating recurrent sCA. We retrospectively evaluated the data of 52 patients with 60 recurrent sCAs who were retreated and 1534 patients with 1817 sCAs who received initial treatment. The primary outcome was a recurrence of the aneurysm. Secondary outcomes were an additional treatment, rupture after treatment, and a neurological worsening, which was defined as an increase of 1 or more scores using the modified Rankin Scale at 12-month. Safety outcomes included postoperative ischemic and hemorrhagic complications. We compiled the 120 (60 each) propensity score-matched cohort based on a propensity score for the treatment of recurrent sCA. In the propensity score-matched cohort, recurrence after treatment was observed in 25% and 6.7% of cases in the retreatment and initial treatment groups, respectively. The odds ratio of recurrence after treatment was 4.7 (95% CI, 1.4-15; P = 0.011). The secondary and safety outcomes were not significantly different between the two groups. This study showed that the treatment of recurrent sCA was a risk factor for recurrence after treatment but not for additional treatment, rupture after treatment, or neurological worsening. Although decision-making regarding the treatment varies depending on the institutional protocols and personal experience of the physicians, endovascular or surgical retreatment could be performed without hesitation.


Asunto(s)
Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/cirugía , Puntaje de Propensión , Reoperación/métodos , Adulto , Anciano , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Embolización Terapéutica/métodos , Embolización Terapéutica/tendencias , Procedimientos Endovasculares/tendencias , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación/tendencias , Retratamiento , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
17.
Neurosurg Rev ; 44(3): 1457-1469, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32535873

RESUMEN

Both posterior decompression and fusion (PDF) and laminoplasty (LAMP) have been used to treat cervical myelopathy due to multilevel ossification of posterior longitudinal ligament (OPLL). However, considerable controversy exists over the choice of the two surgical strategies. Thus, the aim of this study is to compare clinical outcomes of PDF and LAMP for treatment of cervical myelopathy due to multilevel OPLL. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials database to identify relevant clinical studies compared with clinical outcomes of PDF and LAMP for cervical OPLL. The primary outcomes including Japanese Orthopaedic Association (JOA) score and recovery rate of JOA were evaluated, and the secondary outcomes involving visual analogue scale (VAS), cervical curvature, OPLL progression rate, complication rate, reoperation rate and surgical trauma were also evaluated using Stata software. A total of nine studies were included in the current study, involving 324 patients. The current study suggests that compared with LAMP, PDF achieves a lower OPLL progression rate, better postoperative cervical curvature and similar neurological improvement in the treatment of multilevel cervical OPLL. However, PDF has a higher complication rate, more surgical trauma and higher postoperative VAS than LAMP.


Asunto(s)
Vértebras Cervicales/cirugía , Descompresión Quirúrgica/tendencias , Laminoplastia/tendencias , Osificación del Ligamento Longitudinal Posterior/cirugía , Complicaciones Posoperatorias/etiología , Fusión Vertebral/tendencias , Vértebras Cervicales/patología , Descompresión Quirúrgica/efectos adversos , Humanos , Laminoplastia/efectos adversos , Osificación del Ligamento Longitudinal Posterior/diagnóstico , Dimensión del Dolor/métodos , Dimensión del Dolor/tendencias , Complicaciones Posoperatorias/diagnóstico , Reoperación/tendencias , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Resultado del Tratamiento
18.
Neurosurg Rev ; 44(3): 1687-1702, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32783077

RESUMEN

A preferred treatment for residual/recurrent pituitary adenomas has not been established. The existence of higher complication rates for revision surgeries remains under debate. This study aimed to compare complication rates of primary and revision transsphenoidal endoscopic surgeries and to identify risk factors for complications. Data from 144 primary and 39 revision surgeries were analysed. The surgical complications evaluated were intraoperative and postoperative cerebrospinal fluid (CSF) leaks; meningitis; permanent diabetes insipidus (DI) and hypopituitarism; worsening visual acuity; ophthalmoplegias; visual field defects; otorhinolaryngological, systemic and vascular complications; and death. The variables that were potentially associated with surgical complications were gender, age, comorbidities, lumbar drain use, duration of lumbar drain use, invasion of the sphenoid and cavernous sinuses, presence and degree of suprasellar expansion, preoperative identification of the pituitary, CSF leaks and intraoperative pituitary identification. Intraoperative CSF leaks, visual field losses and worsening visual acuity were more common for revision surgeries. There were no between-group differences in the occurrence of postoperative CSF leaks; systemic, vascular and otorhinolaryngological complications; meningitis; DI and hypopituitarism; ophthalmoplegias; or death. Intraoperative identification of the pituitary was associated with lower rates of permanent DI and hypopituitarism, systemic complications, intraoperative CSF leaks and worsening visual acuity. Suprasellar expansion increased the risk of intraoperative CSF leaks but not endocrinological deficits or visual impairment. Intraoperative CSF leaks were associated with postoperative CSF leaks, meningitis, anterior hypopituitarism, DI and worsening visual acuity. Intraoperative CSF leaks, worsening visual acuity and visual field losses were more common in reoperated patients.


Asunto(s)
Adenoma/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Neoplasias Hipofisarias/cirugía , Complicaciones Posoperatorias/etiología , Reoperación/efectos adversos , Hueso Esfenoides/cirugía , Adenoma/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/etiología , Niño , Drenaje/efectos adversos , Drenaje/tendencias , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/tendencias , Neoplasias Hipofisarias/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Reoperación/tendencias , Estudios Retrospectivos , Factores de Riesgo , Hueso Esfenoides/diagnóstico por imagen , Adulto Joven
19.
Spine (Phila Pa 1976) ; 46(8): E498-E504, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33186273

RESUMEN

STUDY DESIGN: A retrospective multicenter cohort study. OBJECTIVE: The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. SUMMARY OF BACKGROUND DATA: Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. METHODS: We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. RESULTS: We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. CONCLUSION: The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.


Asunto(s)
Cifosis/cirugía , Quirófanos/tendencias , Complicaciones Posoperatorias/cirugía , Reoperación/tendencias , Escoliosis/cirugía , Fusión Vertebral/tendencias , Adolescente , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Cifosis/epidemiología , Masculino , Complicaciones Posoperatorias/epidemiología , Prótesis e Implantes/efectos adversos , Prótesis e Implantes/tendencias , Estudios Retrospectivos , Factores de Riesgo , Escoliosis/epidemiología , Fusión Vertebral/efectos adversos
20.
Spine (Phila Pa 1976) ; 46(8): E482-E490, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33186274

RESUMEN

STUDY DESIGN: Retrospective. OBJECTIVE: The purpose of this study is to evaluate the effect of posterior cervical fusion lowest instrumented vertebra (PCF LIV) selection on incidence of mechanical failure, revision surgery, and patient-reported outcomes (PROs). SUMMARY OF BACKGROUND DATA: Recent studies indicate that the LIV in PCF may contribute to the risk of mechanical failure. To date, the evidence available to guide spine surgeons in the selection of PCF LIV remains limited. METHODS: All patients undergoing PCF at a single institution were prospectively entered into a spine registry which was retrospectively queried. Data collection included demographics, pathology, operative variables, construct LIV, outcomes of mechanical failure, revision surgery, and patient-reported disability, pain, and quality of life. RESULTS: Of 438 patients undergoing PCF from 2006 to 2019, 106 patients had an LIV of C7, T1, or T2, a minimum of 1-year follow-up, and met all study inclusion criteria. LIV cohorts were C7 LIV (36), T1 LIV (42), and T2 LIV (28). There were no between-group differences in patient demographics, operative variables, or postoperative follow-up across the three LIV cohorts. Mechanical failure rates for C7, T1, and T2 LIV were 30.6%, 23.8%, and 0%, respectively (P = 0.007). Revision rates for C7, T1, and T2 LIV were 25.0%, 11.9%, and 0%, respectively (P = 0.013). No difference was noted in average time to revision/failure between C7 (39.68 months) and T1 (29.85 months) LIV cohorts. No differences in baseline, 3-month, and 12-month postoperative PRO measures were noted in the C7 and T1 LIV cohort when compared to the T2 LIV cohort. CONCLUSION: The findings in this study indicate that PCF LIV selection may play a significant role in the development of mechanical complications and need for revision surgery. T2 LIV selection demonstrated a significantly lower rate of mechanical failure and revision surgery. Postoperative PROs up to 36 months are needed to evaluate effect of LIV selection on PROs.Level of Evidence: 3.


Asunto(s)
Vértebras Cervicales/cirugía , Medición de Resultados Informados por el Paciente , Reoperación/tendencias , Fusión Vertebral/tendencias , Vértebras Torácicas/cirugía , Anciano , Vértebras Cervicales/diagnóstico por imagen , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Fusión Vertebral/efectos adversos , Vértebras Torácicas/diagnóstico por imagen , Insuficiencia del Tratamiento
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