Long-Term Retrograde Global Amnesia Following Minor Trauma.

BACKGROUND Retrograde amnesia has several causes and may be the core concern in several conditions. When acute, somatic, and neurologic causes are excluded, along with substance use, a consideration of psychiatric disease is imminent. Here, we present a case with amnesia, where diagnostics and treatment were challenging due to severe psychiatric symptoms and course of the disease. CASE REPORT After a minor trauma while driving an electric scooter, a 41-year-old man lost all memories of the past 20 years. The patient was raised in a refugee camp, where he experienced traumatic events, and later came to Denmark and established family and work life. He had 1 prior contact with the psychiatric ward. After the incident, the patient was brought to the emergency room. The patient could not recognize his wife or children and believed he was 21 years old and living with his mother in the refugee camp. A full somatic and neurological workup was performed and no somatic or organic cause could explain the retrograde amnesia. He developed post-traumatic stress disorder (PTSD) and psychotic symptoms. Treatment consisted of a combination of psychoeducation, cognitive remediation, and medical treatment for psychotic symptoms and PTSD. CONCLUSIONS The diagnosis "prolonged delirium", "PTSD", and "dissociative amnesia" were considered. Psychiatric comorbidity and previous traumatic experiences might have contributed to the development of long-term amnesia, which eventually was considered to be dissociative. During 8 months, the patient slowly regained his memory. It is impossible to conclude with certainty whether the successful outcome was the result of psychological treatment, pharmacological treatment, the passing of time, or a mixture of these.

Randomized double blind clinical trial of ABM/P-15 versus allograft in noninstrumented lumbar fusion surgery.

BACKGROUND CONTEXT: Due to poor bone stock in the elderly, a noninstrumented fusion is commonly performed in Scandinavia when instability is present. Allograft bone is often used as graft extender with consequent low fusion rates. The use of 15 amino acid residue (ABM/P-15) has shown superior fusion rates in dental and cervical spinal surgery but no clinical studies have been conducted in noninstrumented lumbar fusion surgery. PURPOSE: To evaluate patient reported outcomes (PROs) and the intertransverse fusion rate in noninstrumented posterolateral fusion with either ABM/P-15 or allograft. STUDY DESIGN: Double-blind randomized clinical trial. PATIENT SAMPLE: Patients 60 years or older with degenerative spondylolisthesis undergoing decompression and noninstrumented posterolateral fusion. OUTCOME MEASURES: Visual analog scales for back and leg pain, Oswestry Disability Index and EuroQoL-5D. METHODS: One hundred one patients were enrolled in the study and randomized 1:1 to either ABM/P-15 (mixed 50/50, 5cc/level) or allograft bone (30 g/level), both mixed with local bone graft. PROs were collected at baseline and at 12 and 24 months after surgery. The patients underwent 1-year postoperative fine cut computed tomography-scans (0.9 mm) with reconstructions, independently evaluated by three reviewers. Fusion status was concluded by consensus of two of the three as "fusion" or "no fusion." RESULTS: There were 49 patients available for analysis in both cohorts. The two groups were similar in terms of sex distribution, age, and number of levels fused. The fusion rate was significantly higher in the ABM/P-15 group with 50% fused compared with 20% in the allograft group. PROs at baseline and at all follow-up time points were similar between the two groups. CONCLUSIONS: Patients undergoing noninstrumented posterolateral fusion augmented with ABM/P-15 had a statistically significantly higher fusion rate compared with allograft when evaluated with postoperative fine cut computed tomography-scans (0.9 mm) with reconstructions. However, this did not translate to better clinical outcomes.

Does Systemic Administration of Parathyroid Hormone After Noninstrumented Spinal Fusion Surgery Improve Fusion Rates and Fusion Mass in Elderly Patients Compared to Placebo in Patients With Degenerative Lumbar Spondylolisthesis?

STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical trial. OBJECTIVE: To evaluate whether 90-day subcutaneous injections with 20 µg teriparatide increases the volume and quality of the fusion mass compared to placebo based on 12-month postop fine cut computed tomography scans. The secondary objective is to evaluate whether parathyroid hormone (PTH) increases fusion rates compared to placebo. SUMMARY OF BACKGROUND DATA: Few studies have investigated the effects of PTH on fusion in patients undergoing spinal arthrodesis. Early studies showed a more robust fusion mass with PTH after spinal fusion surgery. But the efficiency of PTH on noninstrumented spinal fusion surgery remains unclear. METHODS: Patients with degenerative spondylolisthesis scheduled for noninstrumented posterolateral fusion were randomized to receive 90-day subcutaneous injections with 20 µg teriparatide (N = 41) or placebo (N = 46) in a 1:1 fashion. Fusion volume and quality was evaluated using 12-month postoperative fine cut computed tomography scans. RESULTS: The two groups were comparable in terms of age, sex, and numbers of levels operated. PTH treatment was well tolerated but provided no additional benefit versus placebo. Fusion rates, the mean volume, and robustness of the fusion mass were similar between the PTH and placebo groups. CONCLUSION: Ninety-day subcutaneous administration of 20 µg teriparatide did not increase fusion volume or improve the quality of the fusion mass in elderly patients compared to placebo after noninstrumented spinal fusion surgery for degenerative spondylolisthesis. LEVEL OF EVIDENCE: 1.

Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review.

PURPOSE: The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient's walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe patient's walking ability. Objective methods to assess walking capacity and performance is being investigated and used alongside the traditional use of PROs. This review of the literature was made to provide an overview of relations between the ODI and outcome measures of walking capacity and performance in spinal stenosis research, and to provide a strategy for improving such measures in future research. METHODS: The review was conducted according to the Prisma Statement. In February 2017, a search was performed in Pubmed, Embase and Cochrane database. Authors independently screened articles by title, abstract, and full text, and studies were included if both authors agreed. Articles with correlation analysis between the ODI, walking capacity and performance measures by accelerometer or GPS were included. RESULTS: The results support a correlation between the ODI and walking capacity measures. The available studies using ODI and accelerometers were too few to reach a conclusion regarding correlation between ODI and walking performance. No articles with GPS measure were identified. CONCLUSIONS: The ODI should not stand alone when evaluating walking limitations in patients with lumbar spinal stenosis. To enable a comprehensive assessment of walking ability, a walking test should be used to assess walking capacity and accelerometers should be investigated and standardized in measuring walking performance. These slides can be retrieved under Electronic Supplementary Material.