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1.
Bone Joint J ; 103-B(3): 547-552, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641421

RESUMO

AIMS: Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. METHODS: We carried out a retrospective review of a single surgeon's prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. RESULTS: Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. CONCLUSION: Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547-552.


Assuntos
Potencial Evocado Motor/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Neurocirúrgicos , Traumatismos da Medula Espinal/prevenção & controle , Doenças da Coluna Vertebral/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
2.
Artigo em Russo | MEDLINE | ID: mdl-33560618

RESUMO

The development of spine neurosurgery raises some questions concerning the methodology, practical significance, treatment and diagnosis of spinal diseases. In this regard, we inevitably turn to the methods of philosophical knowledge as a basis for analysis and synthesis of scientific information. This approach allows you to avoid mistakes in practice, which can have negative ethical and socio-economic consequences for society. Some controversial issues of spine surgery are discussed in the manuscript. Advisability of syndromic approach in the treatment of spine diseases, determining the length of spine fusion for injury, prediction of postoperative segmental instability due to osteoporosis and extrapolation of the principles of spine fusion surgery to arthroplasty are considered through the prism of philosophical categories.


Assuntos
Neurocirurgia , Doenças da Coluna Vertebral , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Filosofia , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral
3.
J Orthop Surg (Hong Kong) ; 29(1): 2309499020988176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33569998

RESUMO

PURPOSE: In this study we investigated on the personal protective equipment (PPE) usage, recycling, and disposal among spine surgeons in the Asia Pacific region. METHODS: A cross-sectional survey was carried out among spine surgeons in Asia Pacific. The questionnaires were focused on the usage, recycling and disposal of PPE. RESULTS: Two hundred and twenty-two surgeons from 19 countries participated in the survey. When we sub-analysed the differences between countries, the provision of adequate PPE by hospitals ranged from 37.5% to 100%. The usage of PPE was generally high. The most used PPE were surgical face masks (88.7%), followed by surgical caps (88.3%), gowns (85.6%), sterile gloves (83.3%) and face shields (82.0%). The least used PPE were powered air-purifying respirators (PAPR) (23.0%) and shoes/boots (45.0%). The commonly used PPE for surgeries involving COVID-19 positive patients were N95 masks (74.8%), sterile gloves (73.0%), gowns (72.1%), surgical caps (71.6%), face shields (64.4%), goggles (64.0%), shoe covers (58.6%), plastic aprons (45.9%), shoes/boots (45.9%), surgical face masks (36.5%) and PAPRs (21.2%). Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE items compared to general waste. CONCLUSIONS: The usage of PPE was generally high among most countries especially for surgeries involving COVID-19 positive patients except for Myanmar and Nepal. Overall, the most used PPE were surgical face masks. For surgeries involving COVID-19 positive patients, the most used PPE were N95 masks. Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE.


Assuntos
/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Ortopedia , Equipamento de Proteção Individual/estatística & dados numéricos , Sociedades Médicas , Doenças da Coluna Vertebral/cirurgia , Ásia , Comorbidade , Estudos Transversais , Humanos , Pandemias , Doenças da Coluna Vertebral/epidemiologia , Inquéritos e Questionários
4.
World Neurosurg ; 148: e689-e694, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33540092

RESUMO

BACKGROUND: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. METHODS: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM). RESULTS: Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July. CONCLUSIONS: In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.


Assuntos
/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Carga de Trabalho , Lesões Encefálicas Traumáticas/cirurgia , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Hemorragia Subaracnóidea/cirurgia , Centros de Atenção Terciária , Reino Unido/epidemiologia , Listas de Espera
5.
Spine (Phila Pa 1976) ; 46(4): E257-E266, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475277

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases. SUMMARY OF BACKGROUND DATA: The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates. METHODS: This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD. RESULTS: Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P < 0.01) and 0.865 (95% CI: 0.771∼0.958, P < 0.01), respectively. CONCLUSION: Our study revealed a significant association between postoperative GAP score and occurrence of ASD after lumbar fusion surgery. Setting surgical goals according to the GAP score may help reduce the occurrence of ASD, especially for S-ASD.Level of Evidence: 4.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia
6.
World Neurosurg ; 148: e282-e293, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33412316

RESUMO

OBJECTIVE: In the wake of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has recommended the temporary cessation of all elective surgeries. The effects on patients' interest of elective neurosurgical procedures are currently unexplored. METHODS: Using Google Trends, search terms of 7 different neurosurgical procedure categories (trauma, spine, tumor, movement disorder, epilepsy, endovascular, and miscellaneous) were assessed in terms of relative search volume (RSV) between January 2015 and September 2020. Analyses of search terms were performed for over the short term (February 18, 2020, to April 18, 2020), intermediate term (January 1, 2020, to May 31, 2020), and long term (January 2015 to September 2020). State-level interest during phase I reopening (April 28, 2020, to May 31, 2020) was also evaluated. RESULTS: In the short term, RSVs of 4 categories (epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the intermediate term, RSVs of 5 categories (miscellaneous, epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the long term, RSVs of nearly all categories (endovascular, epilepsy, miscellaneous, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. Only the movement disorder procedure category had significantly higher RSV in states that reopened early. CONCLUSIONS: With the recommendation for cessation of elective surgeries, patient interests in overall elective neurosurgical procedures have dropped significantly. With gradual reopening, there has been a resurgence in some procedure types. Google Trends has proven to be a useful tracker of patient interest and may be used by neurosurgical departments to facilitate outreach strategies.


Assuntos
Procedimentos Cirúrgicos Eletivos , Comportamento de Busca de Informação , Internet , Procedimentos Neurocirúrgicos , Ferramenta de Busca , Neoplasias Encefálicas/cirurgia , Transtornos Cerebrovasculares/cirurgia , Traumatismos Craniocerebrais/cirurgia , Estimulação Encefálica Profunda , Procedimentos Endovasculares , Epilepsia/cirurgia , Humanos , Transtornos dos Movimentos/terapia , Implantação de Prótese , Doenças da Coluna Vertebral/cirurgia
7.
Spine (Phila Pa 1976) ; 46(1): 41-47, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32947500

RESUMO

STUDY DESIGN: Report of surgical technique and long-term outcome; review of prospectively gathered data and follow-up survey of patient cohort. OBJECTIVE: The aim of this study was to review surgical technique for a trephine graft harvest technique and assess perioperative complications/pain, long-term outcome, and patient satisfaction after anterior iliac crest bone graft (ICBG) harvest for anterior cervical fusion. SUMMARY OF BACKGROUND DATA: Rates of complications and residual pain after ICBG harvest have reduced its utility as a source of autograft for spinal fusion. Less invasive options reduce morbidity, and trephine harvest is a simple technique, with low morbidity and perioperative and long-term pain. It has not been presented in the peer-reviewed spine literature, and the long-term experience has not been previously reported. METHODS: Sixty-eight patients undergoing anterior cervical discectomy and fusion (ACDF), using allograft spacers, underwent ICBG harvest using a 3.5 mm trephine by a minimally invasive approach. Perioperative complications, pain incidence and Visual Analog Scale (VAS) were analyzed. Thirty consecutive patients were subsequently surveyed for long-term follow-up regarding pain, function, and satisfaction. RESULTS: No perioperative (0-6 weeks) graft-site complications (infection, hematoma, fracture, wound dehiscence) occurred. There were no reoperations, and no treatment required for graft-site complaints. No patient reported clinically significant perioperative pain (>3/10). At long-term follow-up (mean 45 months) no patients reported pain >3/10 at their graft-site, and the mean VAS was 0.20/10. No patient was impaired by graft-site symptoms, and all were satisfied with their graft harvest. CONCLUSION: Trephine graft harvest minimizes soft tissue dissection, periosteal elevation, and cortical disruption. Outcome using this technique eliminated perioperative complications in this study group, and reduced pain in both perioperative and long-term assessments. Compared to historical outcomes, trephine harvest provides sufficient graft with comparable or improved results relative to other minimally invasive approaches, and significantly improved relative to traditional open techniques. LEVEL OF EVIDENCE: 4.


Assuntos
Transplante Ósseo/efeitos adversos , Transplante Ósseo/métodos , Discotomia/efeitos adversos , Ílio/cirurgia , Adulto , Idoso , Fraturas Ósseas/cirurgia , Humanos , Pessoa de Meia-Idade , Morbidade , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Complicações Pós-Operatórias , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Coluna Vertebral/cirurgia , Inquéritos e Questionários , Transplante Autólogo , Resultado do Tratamento
8.
Bone Joint J ; 103-B(1): 157-163, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380205

RESUMO

AIMS: This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. METHODS: We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed. RESULTS: The significant risk factors (p < 0.050) for ULP were OPLL (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.29 to 2.75), foraminotomy (OR 5.38, 95% CI 3.28 to 8.82), old age (per ten years, OR 1.18, 95% CI 1.03 to 1.36), anterior spinal fusion (OR 2.85, 95% CI 1.53 to 5.34), and the number of operated levels (OR 1.25, 95% CI 1.11 to 1.40). OPLL was also a risk factor for neurological deficit except ULP (OR 5.84, 95% CI 2.80 to 12.8), dural tear (OR 1.94, 95% CI 1.11 to 3.39), and dural leakage (OR 3.15, 95% CI 1.48 to 6.68). Among OPLL patients, dural tear and dural leakage were frequently observed in those with a canal-occupying ratio ≥ 50%. Cervical rheumatoid arthritis (RA) was a risk factor for SSI (OR 10.1, 95% CI 2.66 to 38.4). CONCLUSION: The high risk of ULP, neurological deficit except ULP, dural tear, and dural leak should be acknowledged by clinicians and OPLL patients, especially in those patients with a canal-occupying ratio ≥ 50%. Foraminotomy and RA were dominant risk factors for ULP and SSI, respectively. An awareness of these risks may help surgeons to avoid surgery-related complications in these conditions. Cite this article: Bone Joint J 2021;103-B(1):157-163.


Assuntos
Vértebras Cervicais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/diagnóstico por imagem
9.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
10.
Arch Osteoporos ; 15(1): 158, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33030619

RESUMO

PURPOSE: Osteoporosis is one of the most common conditions among adults worldwide. It also presents a challenge among patients undergoing spinal surgery. Use of Teriparatide and bisphosphonates in such patients has been shown to improve outcomes after fusion surgery, including successful fusion, decreased risk of instrumentation failure, and patient-reported outcomes. Herein, we performed a systematic review and indirect meta-analysis of available literature on outcomes of fusion surgery after use of bisphosphonates or Teriparatide. METHODS: We conducted a comprehensive search of all databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) to identify studies assessing outcomes of spinal fusion among osteoporotic patients after use of Teriparatide or bisphosphonate. Four authors independently screened electronic search results, and all four authors independently performed study selection. Two authors performed independent data extraction and assessed the studies' risk of bias assessment using standardized forms of Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). RESULTS: Nineteen studies were included in the final analysis. A total of 13 studies evaluated the difference in fusion rate between bisphosphonates and Teriparatide or control group. Fusion rate was higher for bisphosphonates (effect size (ES) 83%, 95% CI 77-89%) compared with Teriparatide (ES 71%, 95% CI 57-85%), with the p value for heterogeneity between groups without statistical significance (p = 0.123). Five studies assessed the impact of using bisphosphonate or Teriparatide on screw loosening. The rate of screw loosening was higher for bisphosphonates (ES 19%, 95% CI 13-25%) compared with Teriparatide (ES 13%, 95% CI 9-16%) without statistical significance (p = 0.52). CONCLUSION: Our results indicate that while both agents may be associated with positive outcomes, bisphosphonates may be associated with a higher fusion rate, while Teriparatide may be associated with lower screw loosening. The decision to treat with either agent should be tailored individually for each patient keeping in consideration the adverse effect and pharmacokinetic profiles.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Osteoporose/tratamento farmacológico , Teriparatida/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Teriparatida/efeitos adversos , Vértebras Torácicas/efeitos dos fármacos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(44): e22990, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126375

RESUMO

BACKGROUND: Pyogenic osteomyelitis of the spine usually occurs in patients over 55 years old with acute osteomyelitis. Surgical treatment and fixation can relieve pain, enhance spinal balance and nerve function, so that patients can walk as soon as possible. Different outcomes of surgical methods include anterior minimally invasive oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). While, there is no consensus on the best treatment for PVO. The goal of the protocol is to compare the clinical consequences between PTA and ORA for treating PVO. METHOD: The experiment is a single-center randomized clinical research. This experiment was admitted by the Ethics Committee of the People's Hospital of Dayi County (Approval number: 1002-084). In all, 50 patients with lumbar vertebral osteomyelitis (LVO) who prepares surgical treatment will be included in the study. We contain adult patients (aged over 18 years) who accept debridement and spinal stabilization with LVO. Cases are removed if there is previous hardware placement, cases who are not confirmed by microbiology, or severe renal and liver dysfunction. The primary outcomes are intraoperative blood loss, operative time, hospital stay, primary failure and recurrence, and bone fusion. The secondary outcomes are postoperative pain score and physical recovery. SPSS Sample Power version 3.0 (IBM, Armonk, NY, USA) is used for data analysis. RESULTS: Table 1 will show the outcomes in both groups. CONCLUSION: This protocol may offer a reliable basis for the effectiveness of the two approaches in the treatment of PVO. TRIAL REGISTRATION NUMBER: researchregistry6046.


Assuntos
Desbridamento/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteomielite/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adulto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Zhonghua Wai Ke Za Zhi ; 58(11): 892-896, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120454

RESUMO

With the advantages of less operative injury and quicker postoperative recovery time, percutaneous endoscopic spine surgery system is currently one of the most widely used minimal invasive spine surgery techniques in China. However, this technique usually requires surgeon to operate in a single cannula, which brings much inconvenience such as limited vision, small range of motion and low efficiency. Meanwhile, the increasingly popular technique of unilateral biportal endoscopic (UBE) surgery possesses the advantages of better operation visual field, more flexible in operation, shorter learning curve period, handier surgical instruments for spine surgeon, and minimize radiation dosage caused by intraoperative fluoroscopy when comparing with single cannula endoscopic technique, since UBE requires an additional portal for surgical instruments while the anther portal is placed for arthroscope and pressure pump irrigation system. This technique has been applied to the treatment of degenerative diseases of cervical and lumbar spine, facet cyst, spinal epidural lipomatosis and abscess, and has achieved satisfactory clinical results.


Assuntos
Descompressão Cirúrgica , Endoscopia , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , China , Endoscopia/instrumentação , Endoscopia/métodos , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos
13.
PLoS One ; 15(9): e0237566, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870946

RESUMO

BACKGROUND: Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. METHODS: We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS: Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models. CONCLUSION: This is the first network meta-analysis providing an overview of the use of teriparatide and bisphosphonate for spinal fusion surgery. Teriparatide treatments are worth to be consider for spinal fusion surgery.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Difosfonatos/uso terapêutico , Fusão Vertebral/métodos , Teriparatida/uso terapêutico , Humanos , Vértebras Lombares/efeitos dos fármacos , Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Vértebras Torácicas/efeitos dos fármacos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
AJR Am J Roentgenol ; 215(3): 534-544, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755228

RESUMO

OBJECTIVE. The purpose of this article is to provide a review of the imaging of spine fixation hardware. CONCLUSION. As the prevalence of neck and back pain continues to increase, so does the number of surgical procedures used to treat such pain. Accordingly, new techniques and hardware designs are used, and the hardware will be seen on postoperative imaging. It is critical that radiologists understand the appropriate imaging modalities for the assessment of spine fixation hardware, recognize the normal imaging appearance of such hardware, and be able to detect hardware-related complications.


Assuntos
Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Dispositivos de Fixação Ortopédica , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Humanos
15.
Spine (Phila Pa 1976) ; 45(14): E839-E846, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609468

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To elucidate factors that determine segmental lordosis after lateral retroperitoneal lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation. SUMMARY OF BACKGROUND DATA: LLIF has been widely used in degenerative lumbar spine surgery. However, the detailed mechanisms that determine segmental lordosis are still unknown. METHODS: A total of 69 patients who underwent LLIF with posterior pedicle screw fixation without posterior osteotomy were analyzed. Computed tomography was performed before and within 2 weeks after surgery, and segmental lordotic angle (SLA) after surgery (Post-SLA) was predicted using multiple regression analysis. Explanatory factors considered in this study included SLA before surgery (Pre-SLA), disc height before surgery (DiscH), cage position (CageP; distance between the center of the cage and the center of the disc, where a positive value indicates an anterior cage position), cage angle (CageA), cage height (CageH), CageH-DiscH (amount of lift up), previous decompression surgery, and level fused. RESULTS: A total of 102 levels were analyzed. Multiple regression analysis revealed that the Post-SLA can be predicted with three independent variables, CageP, Pre-SLA, and CageH-DiscH and the adjusted R was 0.70. In cases when the cage was located anteriorly (CageP > 3 mm), Post-SLA was greater with larger CageH, larger CageA, and larger Pre-SLA. When the cage was located in the middle (3 mm ≤CageP ≤-1 mm), Post-SLA was greater with larger CageP, larger Pre-SLA, and without previous decompression surgery. If the cage was located posteriorly (CageP < -1 mm), Post-SLA was greater with smaller CageH-DiscH and greater Pre-SLA. CONCLUSION: To gain maximum segmental lordosis in LLIF, the cage should be located anteriorly. Furthermore, if the cage can be located anteriorly, a thicker cage with proper angle cage will gain segmental lordosis. If the cage is located posteriorly, a thin cage should be selected. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Humanos , Lordose , Postura/fisiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 45(15): 1055-1061, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675611

RESUMO

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate the effectiveness and safety of antifibrinolytic (AF) agents in reducing perioperative blood transfusion in pediatric patients undergoing spinal fusion. SUMMARY OF BACKGROUND DATA: The potential for AF to decrease bleeding and reduce exposure to allogenic transfusions has led to widespread off-label use in a number of major pediatric surgical procedures. Recent reviews call for improving the body of evidence for their effectiveness and safety in pediatric spinal fusion. METHODS: Children undergoing spinal fusion were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2016 and 2017 databases. Univariate analyses of patient and perioperative characteristics informed the creation of a propensity score model predicting treatment with AF, followed by 1:1 matching to allow comparison of allogenic red blood cell transfusion rates and secondary outcomes between treated and untreated patients. RESULTS: Of 6626 total patients, 5434 (81%) received AF and 1533 (23%) received a blood transfusion. Analysis of data for 1192 propensity score-matched pairs revealed that treatment with AF was associated with a statistically nonsignificant 16% reduction in perioperative transfusion (OR 0.84, 95% confidence interval 0.68-1.05, P = 0.119) and a statistically significant 43% reduction in postoperative transfusion (OR 0.57, 95% confidence interval 0.39-0.81, P = 0.002). No differences in the incidences of postoperative seizure or thrombosis were observed, with overall rates of 7.5 and 22.5 events per 10,000 patients, respectively. CONCLUSION: AF agents appear to reduce postoperative allogenic transfusion in children undergoing spinal fusion surgery. Adverse drug effects such as thromboembolic complications and seizure were extremely rare and warrant continued monitoring, though this is the largest study to date providing evidence for the safety profile of these drugs. LEVEL OF EVIDENCE: 3.


Assuntos
Antifibrinolíticos/uso terapêutico , Bases de Dados Factuais/tendências , Transfusão de Eritrócitos/tendências , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Fusão Vertebral/tendências , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos
17.
Spine (Phila Pa 1976) ; 45(15): 1073-1080, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675615

RESUMO

STUDY DESIGN: Retrospective cohort study using prospectively collected data. OBJECTIVE: Determine the association between satisfaction with physician communication and patient-reported outcomes in the inpatient spine surgery setting. SUMMARY OF BACKGROUND DATA: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys measure the patient experience of care and influence reimbursement for hospital systems and providers in the United States. It is not known whether patient satisfaction with physician communication is associated with better outcomes after spine surgery. Therefore, we evaluated the association between patient satisfaction with physician communication on the HCAHPS survey and improvements in validated patient-reported outcomes measures in a spine surgery population. METHODS: HCAHPS responses were obtained for patients undergoing elective cervical or lumbar spine surgery from 2013 to 2015. Patient-reported health status measures were the primary outcomes, including EuroQol Five Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Visual Analog Scores for Back and Neck Pain (VAS-BP/NP). The association between satisfaction with communication and preoperative to 1 year postoperative changes in each health status measure was evaluated utilizing multivariable linear regression models. RESULTS: Our study included 648 patients, of which, 479 (74.4%) created our satisfied cohort. Demographically, our two cohorts were similar with regards to preoperative clinical measures; however, the satisfied cohort had a higher self-rating of their mental health (P < 0.01), and overall health (P < 0.01). After adjusting for clinically relevant confounders, our results demonstrated no significant association between satisfaction with physician communication and improvement in EQ-5D (P = 0.312), PDQ (P = 0.498), or VAS pain scores (P = 0.592). CONCLUSION: Patient satisfaction with physician communication was not associated with 1-year postoperative improvement in EQ-5D, PDQ, and VAS-Pain after spine surgery. These findings do not diminish the importance of effective communication between doctor and patient, but instead suggest that within the spine surgery setting, using only patient experience data may not accurately reflect the true quality of care received during their inpatient stay. LEVEL OF EVIDENCE: 3.


Assuntos
Comunicação , Procedimentos Cirúrgicos Eletivos/psicologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Relações Médico-Paciente , Doenças da Coluna Vertebral/psicologia , Adulto , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Inquéritos e Questionários
18.
Spine (Phila Pa 1976) ; 45(15): 1081-1088, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675616

RESUMO

STUDY DESIGN: Longitudinal Cohort Study OBJECTIVE.: The aim of this study was to determine whether duration of postoperative opioids is associated with long-term outcomes, and if initial postoperative opioid dosage is associated with opioid cessation after spine surgery. SUMMARY OF BACKGROUND DATA: Preoperative opioid use is associated with poor outcomes, but little evidence exists regarding the implications of opioid dosage and duration after spine surgery. METHODS: Data from our state's prescription drug database was linked to our prospective clinical spine registry to analyze opioid dispensing and outcomes in elective surgical spine patients between 2010 and 2017. Patients were stratified based on preoperative chronic opioid use and multivariable regression was used to assess associations between duration of postoperative opioids and outcomes at one year, including satisfaction, chronic opioid use, and meaningful improvements in pain, disability, and quality of life. In a secondary aim, a Cox proportional hazards model was used to determine whether initial postoperative opioid dosage was associated with time to opioid cessation. RESULTS: Of 2172 patients included, 35% had preoperative chronic opioid use. In patients without preoperative chronic opioid use, a postoperative opioid duration of 31 to 60 days was associated with chronic opioid use at 1 year (adjusted odds ratio [aOR]: 4.1 [1.7-9.8]) and no meaningful improvement in extremity pain (aOR: 1.8 [1.3-2.6]) or axial pain (aOR: 1.6 [1.1-2.2]); cessation between 61 and 90 days was associated with no meaningful improvement in disability (aOR: 2 [1.3-3]) and dissatisfaction (aOR:1.8 [1-3.1]). In patients with preoperative chronic opioid use, postoperative opioids for ≥90 days was associated with dissatisfaction. Cox regression analyses showed lower initial postoperative opioid dosages were associated with faster opioid cessation in both groups. CONCLUSION: Our results suggest that a shorter duration of postoperative opioids may result in improved 1-year patient-reported outcomes, and that lower postoperative opioid dosages may lead to faster opioid cessation. LEVEL OF EVIDENCE: 2.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Medidas de Resultados Relatados pelo Paciente , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo
19.
Ann Otol Rhinol Laryngol ; 129(11): 1101-1109, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32500729

RESUMO

OBJECTIVES: To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS). METHODS: 129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status. RESULTS: The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls (P > .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness (P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 (P < .0125). CONCLUSION: Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors.Level of Evidence: 3b.


Assuntos
Transtornos de Deglutição/diagnóstico , Deglutição/fisiologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Fluoroscopia/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doenças da Coluna Vertebral/cirurgia , Estudos de Casos e Controles , Vértebras Cervicais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Inferior/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
20.
J Plast Reconstr Aesthet Surg ; 73(8): 1499-1505, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32546424

RESUMO

BACKGROUND: Complex spine surgery in patients with major comorbidities leads to increased need for midline back wound reconstruction by plastic surgeons. Literature suggests that back wound reconstruction concurrent with high-risk immediate/index spine surgery may lead to fewer complication. This study aimed to validate this claim in a large cohort treated at a tertiary center. We hypothesize that immediate reconstruction may lead to fewer adverse events in comparison to delayed reconstruction. METHODS: This was a retrospective single-center review of 659 patients who underwent spinal surgery with/without reconstruction by plastic surgeons between November 2011 and December 2015. Three main cohorts were evaluated: patients who underwent spinal surgery with no reconstruction, patients with delayed reconstruction after spine surgery, and patients with immediate back wound reconstruction with index spine surgery. Demographic, clinical, and outcomes data were collected from electronic medical records. Primary endpoints were the incidence of any complications such as dehiscence, infection, seroma/hematoma, and exposed hardware. The secondary endpoint was return to the operating room and most recent follow-up. RESULTS: Forty-three patients underwent index reconstruction (follow-up 25.3 ± 12.7 months), 33 were delayed (follow-up 23.7 ± 12.5 months), and 583 had no reconstruction (follow-up 22.1 ± 15.2 months). Patients who underwent index reconstruction had more spinal levels involved than delayed reconstruction (7.8 ± 0.75 vs 5.6 ± 0.68; p = 0.03). The overall complications rate was 7.7%, most commonly wound dehiscence (2.7%), infections (0.9%), exposed hardware (2.0%), cerebrospinal fluid leaks (0.6%), and return to OR (3.8%). Patients who underwent index spinal wound reconstruction had a significantly lower complication rate (4.65%) than secondary spinal surgery patients (27.3%; p = 0.048). CONCLUSIONS: The data confirmed significantly decreased complication rates for index back wound reconstructions for high-risk patients compared to delayed spine wound reconstruction. Increased rates of wound dehiscence, exposed hardware, and revisions occurred with delayed reconstruction. Early employment of tension free, robust vascular flap closure may attribute to a decreased complication profile.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/métodos , Doenças da Coluna Vertebral/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
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