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1.
Artigo em Inglês | MEDLINE | ID: mdl-34300038

RESUMO

The human body is characterized by the variability of the characteristics of body build, which is expressed in the instability of spinal curvatures, which change during ontogeny. This phenomenon leads to a phylogenetic evolution of the human body build and posture. The aim of the study was to assess the dynamics of the variability of traits and indices of body build and posture and their mutual relations. It was assumed that over the 10-year observation period, a significant variability and relationships will be observed between the characteristics of body build and posture in young adults. Between 2006 and 2016, 2154 women and men aged 19.6 ± 0.8 were examined (first-year students at the University of Economics in Katowice, Poland). Measurements of basic anthropometric measurements and angular values of lumbar lordosis and thoracic kyphosis were performed. The collected data were analysed statistically, and the intergroup and intragroup differences were evaluated (ANOVA with repeated measures). The dynamics of variability (by building time series) and absolute and single-base increments were determined. The body build of young men and women in the period of ontogenetic stabilization in the study group has changed statistically significantly over the decade. A prediction of the increases in body weight and hip circumference was recorded over a period of 10 years, especially in men. The characteristics of body posture have also undergone a significant progressive change. In women, thoracic kyphosis increased by 96.15%, whereas in men, lumbar lordosis decreased by 52.65%. Significant sexual differentiation was shown for such characteristics as body height, waist circumference and the angle of lumbar lordosis. The relationships between the characteristics of body build and posture were verified. There was a moderate relationship between the hip circumference and lumbar lordosis in women and a weak relationship between body height and the angle of thoracic kyphosis in men.


Assuntos
Somatotipos , Curvaturas da Coluna Vertebral , Adolescente , Feminino , Humanos , Estudos Longitudinais , Vértebras Lombares , Masculino , Filogenia , Polônia , Curvaturas da Coluna Vertebral/epidemiologia , Adulto Jovem
2.
BMC Neurol ; 21(1): 181, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910524

RESUMO

BACKGROUND: Camptocormia is common in patients with multiple system atrophy (MSA). The current study was aimed at assessing the frequency of camptocormia and its related factors in MSA patients with different disease durations. Also, the impact of camptocormia on disability was evaluated. METHODS: A total of 716 patients were enrolled in the study. They were classified into three groups based on disease duration (≤ 3, 3-5, ≥ 5 years). Specific scales were used to evaluate the motor and non-motor symptoms. Disease severity was assessed using the Unified Multiple System Atrophy Rating Scale (UMSARS). The binary logistic regression model was used to explore the factors related to camptocormia. To analyze the impact of camptocormia on disability in patients with disease duration less than 5 years, propensity score matching (PSM) and stratified Cox regression analysis were used. RESULTS: In the current study, we found that the frequency of camptocormia was 8.9, 19.7 and 19.2% when the disease duration was ≤3, 3-5, ≥ 5 years, respectively. In the disease duration ≤3 years group, we found that MSA-parkinsonian subtype (MSA-P) (OR = 2.043, P = 0.043), higher total UMSARS score (OR = 1.063, P < 0.001), older age of onset (OR = 1.047, P = 0.042), and lower score on the frontal assessment battery (FAB) (OR = 0.899, P = 0.046) were associated with camptocormia. Only greater disease severity was associated with camptocormia in the group of patients with disease duration 3-5 years (OR = 1.494, P = 0.025) and in the group of patients with disease duration ≥5 years (OR = 1.076, P = 0.005). There was no significant impact of camptocormia on disability in patients with a disease duration of < 5 years (HR = 0.687, P = 0.463). CONCLUSION: The frequency of camptocormia increased with prolonged disease duration. Disease severity was related to camptocormia at different stages of the disease. The MSA-P subtype, older age of onset, and lower FAB score were associated with camptocormia in the early stage of the disease.


Assuntos
Atrofia de Múltiplos Sistemas/complicações , Atrofia Muscular Espinal/etiologia , Curvaturas da Coluna Vertebral/etiologia , Idade de Início , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Curvaturas da Coluna Vertebral/epidemiologia
3.
World Neurosurg ; 140: 519-526, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797984

RESUMO

BACKGROUND: The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. METHODS: A literature search of the last 10 years was done. RESULTS: Outcomes of spine surgery using decompressive techniques only are similar to outcomes in younger patients. However, in patients with comorbidities, the outcomes are less favorable with more complications. Complication rates decrease when minimally invasive techniques are used. If a fusion surgery is necessary, especially in cases with deformity correction, complication rates significantly increase up to 60%. Osteoporosis comanagement is necessary to prevent nonunion and implant failure if a fusion surgery is planned. Enhanced recovery after surgery protocols can be an aid to preparation and rehabilitation of elderly patients. A frailty index can help to predict patients with the worst outcomes. Additional psychological support and some other measures will help to reduce the incidence of postoperative delirium. CONCLUSIONS: Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.


Assuntos
Delírio/prevenção & controle , Fragilidade/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Osteoporose/terapia , Complicações Pós-Operatórias/prevenção & controle , Doenças da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Descompressão Cirúrgica , Delírio/epidemiologia , Progressão da Doença , Recuperação Pós-Cirúrgica Melhorada , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos/reabilitação , Procedimentos Ortopédicos/métodos , Osteoporose/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Manejo da Dor , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia , Doenças da Coluna Vertebral/epidemiologia , Fusão Vertebral
4.
Spine Deform ; 8(6): 1353-1359, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32696446

RESUMO

STUDY DESIGN: Retrospective study of a prospectively collected database at one center. OBJECTIVES: Assess the outcomes and complications of adult spinal deformity (ASD) surgery in patients that are 75 years and older compared with patients of 65-75 years of age. With increasing amounts of ASD surgery being performed on elderly patients, it is important to assess how age plays a factor in corrective reconstruction surgery. METHODS: Inclusion criteria for the study were all patients ≥ 65 years of age that underwent thoracolumbar deformity correction involving ≥ four levels at a single institution by two surgeons. Patients were divided based on age into 65-74.9 or ≥ 75 groups. Radiographic parameters were measured preoperatively, postoperatively, and at 2 years. The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were collected preoperatively, at 1 year, and 2 years. Comorbidities included were based around the Charlson Comorbidity Index (CCI) and compared to the incidence of complications and need for further surgery. RESULTS: Both age groups had improvements in their radiographic parameters postoperatively which was maintained at 2 years. Comparing the different age groups with similar comorbidity burden in regard to complications and need for additional surgery yielded no statistically significant difference between groups. Both groups had comparable decreases in NRS and increases in ODI at 2 years. CONCLUSIONS: Analysis of our study population indicates that there is no difference between the outcomes and complications of deformity surgery in patients 75 years and older when compared to a younger elderly population. It also does not appear that a ≥ 3 comorbidity burden has a significant impact on the complications or need for additional surgery in our elderly spinal deformity surgery population. LEVEL OF EVIDENCE: Level IV.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Procedimentos Cirúrgicos Reconstrutivos , Curvaturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Fatores Etários , Idoso , Comorbidade , Bases de Dados como Assunto , Feminino , Humanos , Incidência , Ácido Iodoipúrico , Vértebras Lombares/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/epidemiologia , Vértebras Torácicas/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
5.
Spine (Phila Pa 1976) ; 45(14): E847-E855, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609469

RESUMO

STUDY DESIGN: Multicenter, retrospective study. OBJECTIVE: The aim of this study was to examine the performance and concurrent validity of the adult spinal deformity surgical decision-making (ASD-SDM) score compared to decision-making factors in the ASD population. SUMMARY OF BACKGROUND DATA: The ASD-SDM score, which has been recently proposed, is a scoring system to guide the selection of treatment modality for the ASD population. To secure the justification for its clinical use, it is necessary to verify its clinical performance and concurrent validity. METHODS: A multicenter prospective ASD database was retrospectively reviewed. The data were analyzed separately in younger (≤40 years) and older (≥41 years) age groups. The discriminating capacity of the ASD-SDM score in cases who selected surgical and nonsurgical management was compared using area under the receiver operator characteristic curves (AUROC). Concurrent validity was examined using Spearman correlation coefficients, comparing factors that are reported to be associated with the decision-making process for ASD, including baseline symptomatology, health-related quality of life measures, and the severity of radiographic spinal deformity. RESULTS: There were 338 patients (mean age: 26.6 years; 80.8% female; 129 surgical and 209 nonsurgical) in the younger age group and 750 patients (mean age: 63.5 years; 84.3% female; 410 surgical and 340 nonsurgical) in the older age group. In both younger and older patients, the ASD-SDM score showed a significantly higher performance for discriminating the surgical and nonsurgical cases (AUROC: 0.767, standard error [SE]: 0.026, P < 0.001, 95% confidence interval [CI]: 0.712-0.813; AUROC: 0.781, SE: 0.017, P < 0.001, 95% CI: 0.747-0.812, respectively) compared to the decision-making factors analyzed. In addition, the ASD-SDM showed significant correlations with multiple decision-making factors. CONCLUSION: The ASD-SDM score alone can effectively grade the indication for surgical management whilst considering multiple decision-making factors. LEVEL OF EVIDENCE: 3.


Assuntos
Regras de Decisão Clínica , Curvaturas da Coluna Vertebral , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/classificação , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia
6.
Spine Deform ; 8(3): 413-420, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112351

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: Analysis of a standardized, pre-surgical psychological evaluation program for complex spine surgery. Adult spinal deformity (ASD) patients have a high rate of comorbid mental health conditions. Although there is a body of literature demonstrating the impact of psychological factors, including anxiety and depression, on spine surgery outcome, it is estimated that spine surgeons utilize a psychological assessment only about one third of the time prior to a patient's spine surgery. At this time, there is not a widely reported pre-surgical psychological evaluation program for ASD patients. METHODS: 129 consecutive complex spine surgery candidates receiving a pre-surgical psychological evaluation were analyzed between January 1st 2014 and December 31st 2018. Based on the available literature and professional experience in our facility, a color code for patients was developed from Green (low psychological or psychosocial co-morbidity) to Red (high psychological or psychosocial co-morbidity). Univariate analysis was used to evaluate between color grades and demographics, mental health disorders and outcomes. RESULTS: 83% of complex spine patients had at least one psychological disorder or psychosocial barrier. Only 17% had a combination of realistic expectations for surgery, a good support plan, and were without a history of mental illness. The pre-surgical psychological color criteria were validated in showing higher rates of major depression, anxiety disorder, and bipolar disorder in moderate to severe color grades (p < .001) in addition to higher PHQ-9 and GAD-7 scores (p < .001). Patients having a more severe color grade had lower rates of a discharge home and were taking higher morphine equivalent dosages (MEDs) at their six-month follow-up, though both did not reach statistical significance (p = .07 and p = .08; respectively). CONCLUSION: A comprehensive pre-surgical psychological evaluation may be beneficial to risk stratify and counsel patients being evaluated for surgical reconstruction of adult spinal deformities. LEVEL OF EVIDENCE: 3.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Procedimentos Ortopédicos , Angústia Psicológica , Testes Psicológicos , Medição de Risco/métodos , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/psicologia , Curvaturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Idoso , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/psicologia , Projetos Piloto , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
7.
BMC Neurol ; 20(1): 34, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973698

RESUMO

BACKGROUND: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. METHODS: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. RESULTS: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7(2.6%)patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6-114 months). In subsequent multivariate logistic regression analysis, age ≤ 18 years (p = 0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p = 0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94-, 0.69- and 27.11-fold, respectively. CONCLUSIONS: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Medula Espinal/cirurgia , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/etiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Medula Espinal/complicações , Adulto Jovem
8.
Eur Spine J ; 29(1): 73-84, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31493111

RESUMO

PURPOSE: To assess pain, health-related quality of life (HRQOL) scores and sagittal parameters of adult spinal deformity (ASD)-operated patients in the context of their analgesic consumption especially opioids (narcotics) over the first year postoperative period. METHODS: In total, 372 patients from a multicenter database were stratified into 3 groups at baseline: 241 patients in the minimal group (no analgesic, or NSAIDs/narcotics weekly or less), 64 in the NSAIDs every day group and 67 in the narcotics every day group. HRQOL and back and leg pain scores were evaluated at 6 months and 1 year postoperatively. Also several sagittal alignment parameters were assessed. RESULTS: Significant improvements in pain and HRQOL scores were observed across all 3 groups by 1 year (P < 0.05) postoperatively. While the minimal group had the best pre- and postoperative HRQOL scores, the NSAID group demonstrated the best improvement in HRQOL. Only the minimal group displayed continued improvement from 6 months to 1 year. 90%, 65% and 40% of minimal, NSAID and narcotic groups of patients, respectively, no longer took any analgesics at 1 year postoperatively. Alternatively, 36% of patients in the narcotics group continued to take narcotics at 1 year. Residual malalignment increased NSAIDs consumption in different groups at 1 year. CONCLUSION: This study evaluated the analgesics use after ASD surgery in relation to the clinical and radiological outcomes. Despite important postoperative opioids consumption in the narcotics group, clinical outcome yet improved. Malalignment parameters demonstrated a predictive value in regard to NSAIDs' usage. These slides can be retrieved under Electronic Supplementary Material.


Assuntos
Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Curvaturas da Coluna Vertebral , Coluna Vertebral/cirurgia , Humanos , Postura , Período Pré-Operatório , Qualidade de Vida , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia
9.
Oper Neurosurg (Hagerstown) ; 18(1): 75-82, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31172190

RESUMO

BACKGROUND: Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up. OBJECTIVE: To assess the incidence of PJK utilizing a high-powered ASD database. METHODS: Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development. RESULTS: A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594). CONCLUSION: Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.


Assuntos
Cifose/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Curvaturas da Coluna Vertebral/epidemiologia , Adulto , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Incidência , Cifose/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Curvaturas da Coluna Vertebral/cirurgia
10.
Neurosurgery ; 87(1): 25-32, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31620794

RESUMO

Adult spinal deformity (ASD) has gained significant attention over the past decade with improvements in diagnostic tools, classification schemes, and surgical technique. The demographics of the aging population in the United States are undergoing a fundamental shift as medical care advances and life expectancy increases. The "baby boomers" represent the fastest growing demographic in the United States and by 2050, the number of individuals 65 yr and older is projected to reach 89 million, more than double its current size. Based on current prevalence estimates there are approximately 27.5 million elderly individuals with some form of spinal deformity, which will place a significant burden on our health care systems. Rates of surgery for ASD and case complexity are both increasing, with concomitant increase in the cost of deformity care. At the same time, patients are more medically complex with increasing number of comorbidities that result in increased surgical risk and complication profiles. This review aims to highlight recent trends in the epidemiology and socioeconomic patterns in surgery for ASD.


Assuntos
Fatores Socioeconômicos , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/terapia , Adulto , Idoso , Comorbidade , Feminino , Humanos , Prevalência , Estados Unidos
11.
Spine Deform ; 7(6): 883-889, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31731998

RESUMO

BACKGROUND: The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort. METHODS: This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications. RESULTS: Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%). CONCLUSIONS: Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment. LEVEL OF EVIDENCE: Level II.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Escoliose/diagnóstico , Escoliose/cirurgia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos , Adolescente , China/epidemiologia , Egito/epidemiologia , Gana/epidemiologia , Acesso aos Serviços de Saúde/tendências , Humanos , Duração da Cirurgia , Paquistão/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Escoliose/complicações , Escoliose/epidemiologia , Índice de Gravidade de Doença , Espanha/epidemiologia , Curvaturas da Coluna Vertebral/epidemiologia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Parkinsonism Relat Disord ; 69: 1-6, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634691

RESUMO

INTRODUCTION: Pisa Syndrome (PS) is a disabling complication in Parkinson's disease (PD) with unclear pathogenesis, yet studies on the longitudinal observation of PS are absent. This study aims to investigate the clinical predictors of PS from a cohort of Chinese PD patients. METHODS: A total of 373 PD patients without PS were prospectively monitored for approximately 2.5 years. Demographic and clinical data were investigated. A penalized logistic regression model was conducted to discriminate the predictive factors of PS. RESULTS: Overall, PS was observed in 22 patients (5.9%) during the study period. At baseline, the following variables including Unified PD Rating Scale (UPDRS) part III score, the axial subscore of UPDRS part III, the modified Hoehn and Yahr (H&Y) stage, the subscore "taste or smell" of the Non-Motor Symptoms Scale (NMSS), proportion of males and rapid eye movement sleep behavior disorder (RBD), were significantly higher in patients with PS compared to those without PS (p < 0.05). The multivariable penalized logistic regression model indicated that the presence of RBD (OR = 4.088, p = 0.003) and higher axial subscore of UPDRS part III (OR = 1.196, p = 0.002) predicted a higher risk of developing PS. CONCLUSION: PD patients with RBD and more severe axial symptoms are more likely to develop PS in the future.


Assuntos
Doença de Parkinson/complicações , Curvaturas da Coluna Vertebral/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Transtorno do Comportamento do Sono REM/etiologia , Curvaturas da Coluna Vertebral/epidemiologia
13.
Osteoporos Int ; 30(12): 2505-2514, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31478068

RESUMO

MrOS (Hong Kong)'s year-4 follow-up shows, for subjects at baseline without vertebral deformity (VD) and endplate or/and cortex fracture (ECF), the VD progression/new VD rate during follow-up in males was half of our paired MsOS (Hong Kong) study's results. For those with VD or ECF, the VD progression/new VD was less than one sixth of females' rate. INTRODUCTION: This study documents MrOS (Hong Kong)'s year-4 follow-up, and the results are compared with the MsOS (Hong Kong) study. Of elderly females with Genant's grade-0, -1, -2, and -3 VD, at year-4 follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or incident VD, respectively. METHODS: Spine radiographs of 1500 Chinese males with baseline (mean age 71.7 years, range 65-91 years) and year-4 follow-up were evaluated according to Genant's VD criteria and ECF (non-existent, ECF0; or existent, ECF1). Grade-2 VDs were divided into mild (VD2m, 25-34% height loss) and severe (VD2s, 34-40% height loss) subgroups. Study subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new VD incident was a change from grade-0 to grade-2/3, or to grade-1 with ≥ 10% height loss. RESULTS: Of subjects with Genant's grade-0, 2.05% (25/1219) developed at least one VD progression or/and new VD, while of subjects with Genant's grade-1, -2, and -3 VD, only 2% (3/149), 3.1% (3/96), and 2.8% (1/36) developed at least one VD progression/new VD, respectively. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. CONCLUSION: VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF.


Assuntos
Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/fisiologia , Progressão da Doença , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Estudos Prospectivos , Radiografia , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia
14.
Spine Deform ; 7(5): 669-683, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31495466

RESUMO

STUDY DESIGN: Structured Literature Review. OBJECTIVES: We sought to evaluate the peer-reviewed literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Lean Methodology uses Standard Work to improve efficiency and decrease waste and error. ASD is known to have a high surgical complication rate. Several patient and surgical potentially modifiable factors have been suggested to affect complications, including preoperative hemoglobin, bone density, body mass index (BMI), age-appropriate realignment, preoperative albumin/prealbumin, and smoking status. We sought to evaluate the literature for evidence supporting these factors to include in a Standard Work protocol to decrease complications. METHODS: Each of these six factors was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). A comprehensive literature search was then performed. The authors reviewed abstracts and analyzed data from included studies. From 456 initial citations with abstract, 173 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 93 included studies. RESULTS: We found fair evidence supporting a low preoperative hemoglobin level associated with increased transfusion rates and decreased BMD and increased BMI associated with increased complication rates. Fair evidence supported low albumin/prealbumin associated with increased complications. There was fair evidence associating smoking exposure to increased reoperations, but conflicting evidence associating it with increased complications. There was no evidence in the literature evaluating age-appropriate realignment and complications. CONCLUSION: Preoperative hemoglobin, bone density, body mass index, preoperative albumin/prealbumin, and smoking status all are potentially modifiable risk factors that are associated with increased complications in the adult spine surgery population. Developing a Standard Work Protocol for patient evaluation and optimization should include these factors. LEVEL OF EVIDENCE: Level II.


Assuntos
Procedimentos Ortopédicos , Complicações Pós-Operatórias , Curvaturas da Coluna Vertebral , Adulto , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia
15.
Spine Deform ; 7(5): 779-787, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31495479

RESUMO

STUDY DESIGN: Retrospective cohort analysis. OBJECTIVES: To identify the effects of preoperative steroid therapy on 30-day perioperative complications after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Chronic steroid therapy has demonstrated therapeutic effects in the treatment of various medical conditions but is also known to be associated with surgical complications. There remains a gap in the literature regarding the impact of chronic steroid therapy in predisposing patients to perioperative complications after elective surgery for ASD. METHODS: We performed a retrospective analysis of data from the 2008-2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into two groups based on preoperative steroid therapy. Differences in baseline patient characteristics, comorbidities, and operative variables were assessed. Univariate analysis was performed to compare the incidence of perioperative complications. Multivariate stepwise logistic regression models were then used to adjust for baseline patient and operative variables in order to identify perioperative complications that were associated with preoperative steroid therapy. RESULTS: We identified 7,936 patients who underwent surgery for ASD, of which 418 (5.3%) were on preoperative steroid therapy. Preoperative steroid therapy was an independent risk factor for four perioperative complications, including mortality (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.30, 4.51; p = .005), wound dehiscence (OR 3.12, 95% CI 1.45, 6.70; p = .004), deep vein thrombosis (DVT) (OR 2.10, 95% CI 1.24, 3.55; p = .006), and blood transfusion (OR 1.34, 95% CI 1.08, 1.66; p < .007). CONCLUSIONS: Patients on preoperative steroid therapy are at increased risk of 30-day mortality, wound dehiscence, DVT, and blood transfusion after surgery for ASD. An interdisciplinary approach to the perioperative management of steroid regimens is critical. LEVEL OF EVIDENCE: Level III.


Assuntos
Procedimentos Ortopédicos , Complicações Pós-Operatórias , Curvaturas da Coluna Vertebral , Esteroides/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/mortalidade , Procedimentos Ortopédicos/estatística & dados numéricos , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Curvaturas da Coluna Vertebral/tratamento farmacológico , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/mortalidade , Curvaturas da Coluna Vertebral/cirurgia
16.
Spine Deform ; 7(5): 788-795, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31495480

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: This study sought to investigate the relationship between preoperative (preop) fibrinogen, bleeding, and transfusion requirements in adult spinal deformity corrections. SUMMARY OF BACKGROUND DATA: Blood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss. METHODS: Data were collected from clinic charts and hospital medical records of all 142 of a single surgeon's consecutive adult spine patients undergoing 7 or more levels deformity correction surgeries from January 2011 to December 2014. t tests were used to compare perioperative variables between patients with total blood loss in the upper quartile (≥1,000 mL) and the remaining patients. Similarly, patients receiving >2 units of packed red cells (PRCs) were compared with others. Analysis of variance was used to compare the blood loss between the patients' groups (quartiles) based on their preoperative fibrinogen concentration. RESULTS: Mean total blood loss was 847.9 (±543.6) mL. Overall, mean preoperative fibrinogen concentration was 254.8 (±82.9) mg/dL. Patients with lower fibrinogen concentration (<193 mg/dL) experienced significantly higher blood loss than those with higher concentrations (p < .05). Patients with transfusion >2 units PRC had significantly greater number of spinal levels treated, higher mean operative time, total blood loss and lower mean preoperative fibrinogen than those transfused 2 or fewer units PRC (p < .05). Total blood loss correlated significantly with preoperative fibrinogen concentration (r = -0.51, p < .05). All the thromboelastography (TEG) variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p < .05). CONCLUSIONS: In our cohort undergoing correction of adult spinal deformity, patients with preoperative fibrinogen level lower than 193 mg/dL had significantly higher bleeding than their counterparts. Perioperative transfusion requirements correlated moderately both with the blood loss and preoperative fibrinogen concentration. Incorporation of preoperative fibrinogen allows better prediction of total perioperative blood loss and may therefore guide the treatment team in use of ameliorating therapies. LEVEL OF EVIDENCE: Level IV.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Fibrinogênio/análise , Procedimentos Ortopédicos , Hemorragia Pós-Operatória/epidemiologia , Curvaturas da Coluna Vertebral , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/sangue , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia
17.
Lancet ; 394(10193): 160-172, 2019 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-31305254

RESUMO

Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.


Assuntos
Vértebras Lombares/anormalidades , Curvaturas da Coluna Vertebral , Vértebras Torácicas/anormalidades , Adulto , Efeitos Psicossociais da Doença , Humanos , Planejamento de Assistência ao Paciente , Exame Físico , Radiografia , Medição de Risco , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/psicologia , Curvaturas da Coluna Vertebral/terapia , Resultado do Tratamento
18.
NeuroRehabilitation ; 44(3): 419-424, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177242

RESUMO

BACKGROUND: Postural deformities, such as Pisa syndrome (PS), and camptocormia and antecollis (C&A) are common in patient with Parkinson's disease (PwPD). These deformities can lead to back disability and pain with different mechanisms, including abnormal loading or stress on soft tissues as muscles, lumbar discs and ligaments. OBJECTIVES: To evaluate the effect of different postural deformities including PS and C&A on back function and pain in PwPD. METHODS: The function, disability and pain were assessed by Oswestry disability index (ODI) and brief pain inventory (BPI). All participants completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). RESULTS: PS and C&A groups significantly showed worse disability ODI and pain BPI, and higher LEDD and mH&Y stage compared with PD groups. However, no differences were found in PD duration and UPDRS in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales. CONCLUSION: These results demonstrated that PS and C&A are associated with severe impairment of back functions and pain. Rehabilitation programs for PwPD and PS, and C&A should include spine alignment and postural training.


Assuntos
Dor nas Costas/fisiopatologia , Atrofia Muscular Espinal/fisiopatologia , Doença de Parkinson/fisiopatologia , Postura/fisiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/epidemiologia , Medição da Dor/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Curvaturas da Coluna Vertebral/diagnóstico , Curvaturas da Coluna Vertebral/epidemiologia
19.
Spine Deform ; 7(4): 610-618, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31202379

RESUMO

STUDY DESIGN: Retrospective analysis of a prospectively collected consecutive case series. OBJECTIVES: To determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients. SUMMARY OF BACKGROUND DATA: Age-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. METHODS: Consecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45-64 years; Elderly, 65-74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between -5° and -20° of ideal LL), and under (under ideal LL by -20°). RESULTS: A total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. CONCLUSIONS: Rigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. LEVEL OF EVIDENCE: Level 4.


Assuntos
Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia , Resultado do Tratamento
20.
Spine Deform ; 7(4): 619-626.e2, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31202380

RESUMO

STUDY DESIGN: Cohort study. OBJECTIVES: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. SUMMARY OF BACKGROUND DATA: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. METHODS: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006-2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1-2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. RESULTS: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105-508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01-1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16-3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01-1.18). CONCLUSIONS: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. LEVEL OF EVIDENCE: Level II.


Assuntos
Reoperação/estatística & dados numéricos , Curvaturas da Coluna Vertebral , Fusão Vertebral , Adulto , Idoso , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos
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