A new nursing pattern based on ERAS concept for patients with lumbar degenerative diseases treated with OLIF surgery: A retrospective study.

Objective: The purpose of this study was to introduce enhanced recovery after surgery (ERAS) concept into patients with lumbar degenerative diseases who were treated with oblique lumbar interbody fusion (OLIF), and to assess whether it could increase clinical efficacy, reduce perioperative complications, shorten length of hospital stay (LHS), decrease readmission rate, and improve patient satisfaction. Methods: The study included patients with lumbar degenerative diseases (LDDs) who underwent OLIF between July 2017 and October 2018 (non-ERAS group), and between November 2018 and July 2020 (ERAS group). The two groups were compared according to the demographic and clinical characteristics. Results: There was no significant difference in descriptive characteristics and concomitant diseases between the two groups. The preoperative Oswestry disability index (ODI) score (P = 0.191), lumbar visual analogue scale (VAS) score (P = 0.470), and leg VAS score (P = 0.657) did not significantly different. Most of the ERAS measures were also well implemented after surgery, except for early delivery (74.2%), early catheter removal (63.9%), and multimodal analgesia (80.6%). The LHS in the ERAS group was significantly shorter than that in the non-ERAS group (P = 0.004). Besides, Hamilton Anxiety Rating Scale (HAMA) score at 3 days after surgery showed a significant difference between the two groups (P = 0.019). The patient satisfaction in ERAS group was significantly higher than that in the non-ERAS group (P = 0.001). Conclusion: The new nursing pattern combined with ERAS in patients with LDDs who underwent OLIF did not improve the short-term prognosis of surgery, while it could effectively reduce postoperative complications, shorten the LHS, and improve patient satisfaction, and did not lead to additional adverse events.

Characteristics of the DXA Measurements in Patients Undergoing Lumbar Fusion for Lumbar Degenerative Diseases: A Retrospective Analysis of Over 1000 Patients.

PURPOSE: To explore the characteristics and reliability of dual-energy x-ray absorptiometry (DXA) measurements in patients undergoing lumbar fusion for lumbar degenerative diseases (LDD). PATIENTS AND METHODS: A total of 1041 patients aged ≥50 years undergoing lumbar fusion for LDD were reviewed. The BMDs and T-scores of DXA were retrospectively analysed. The diagnosis of osteoporosis was in accordance with World Health Organization (WHO) criteria. Based on the guidelines of International Society for Clinical Densitometry (ISCD), an abnormal lumbar segment is identified as having unreliable T-scores when there is more than a 1.0 T-score difference between two adjacent vertebrae. RESULTS: The prevalence of osteoporosis diagnosed on DXA was 42.3%, and it was higher in women than in men (50.2% vs 31.8%, P < 0.001). Increasing age resulted in higher prevalence of osteoporosis in females. The prevalence of osteoporosis significantly declined with increasing BMI. The lowest lumbar T-score was mostly found at L1. Unreliable T-scores were mostly seen in the lower lumbar segment (L3-L4) and were the least common in L1-L2. The average amount of abnormal lumbar segments increased with age (P = 0.003) and BMI (P = 0.021). Furthermore, those with degenerative lumbar scoliosis had more abnormal segments (P < 0.001). Of the 95 patients with at least one fractured vertebra, 39 (41.1%) were not diagnosed as having osteoporosis on lumbar DXA. CONCLUSION: Female, older age and low BMI are the risk factors for osteoporosis in patients undergoing lumbar fusion for LDD. Lower lumbar segments, such as L3-L4, are more likely to have unreliable T-scores. Patients with older age, higher BMI or degenerative scoliosis have more abnormal segments with unreliable T-scores. Lumbar DXA measurements are not sensitive enough to identify patients with vertebral fracture.

Effectiveness of personalized 3D printed models for patient education in degenerative lumbar disease.

OBJECTIVE: Three-dimensional printing may play an important role in patients' education. The objective of this study was to assess the effectiveness of personalized 3D printed models for increasing patient understanding of their medical condition and surgical plan. METHODS: Forty-five patients with degenerative lumbar diseases were randomized by block design into three groups: educational program presented by CT & MRI imaging (care-as-usual), 3D reconstructions, or personalized 3D printed models. Patients' level of understanding and satisfaction were evaluated by two questionnaires one day after education. RESULTS: Patients educated with personalized 3D printed models demonstrated an expanded level of understanding than patients educated with CT & MRI imaging (care-as-usual) (P ＜ 0.05) and 3D reconstructions (P ＜ 0.05). Personalized 3D printed models also resulted in a higher degree of patient satisfaction (P ＜ 0.05). CONCLUSIONS: Personalized 3D printed models and 3D reconstructions can simplify and enhance understanding of lumbar anatomy, physiology, and patients' disease and surgical plan. Personalized 3D printed models also enhance patients' subjective satisfaction. PRACTICE IMPLICATIONS: Personalized 3D printed models for patient education are feasible and could be generalized for degenerative lumbar diseases.

Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis.

BACKGROUND: The aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation. METHODS: This study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0 T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides. RESULTS: For L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (p = 0.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (p = 0.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (p = 0.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (p = 0.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (p = 0.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (p = 0.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (p = 0.000). CONCLUSION: At the L4-5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4-5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon.