Incidence of acute spinal cord injury and associated complications of methylprednisolone therapy: a national population-based study in South Korea.

STUDY DESIGN: Retrospective population-based cohort study OBJECTIVES: To evaluate the incidence of acute spinal cord injury (SCI) in South Korea, and the prescription rates and complications related to high dose methylprednisolone therapy. SETTING: Health Insurance Review and Assessment Service (HIRA) data METHODS: National database of the Korean HIRA between 2007 and 2017 was reviewed. To identify patients with acute SCI and the use of high dose methylprednisolone, International Classification of Disease revision codes, medical behavior codes and examination codes were used. Patients were grouped according to whether or not they received methylprednisolone therapy (MP group vs non-MP group). RESULTS: The average age-adjusted incidence of acute SCI per 1,000,000 persons was 26.4 and the peak incidence was in the 50s overall. The methylprednisolone prescription rate was highest in 2012 (76%) and continued to decrease thereafter, being lowest in 2017 (41%). The MP group showed higher complication rates in terms of pneumonia (OR 1.8, 95% CI, 1.62-2.0), GI bleeding (OR 1.2, 95% CI, 1.05-1.38), and UTI (OR 1.68, 95% CI, 1.53-1.84). The average length of hospitalization was longer in patients who received methylprednisolone (26.5 days vs. 24.4 days, p < 0.05). CONCLUSIONS: The average age-adjusted incidence of acute SCI for 11 years was 26.4 per 1,000,000 persons and highest in 50s. Strategies should be established, and national health resources should be allocated to prevent acute SCI from occurring in older people. The prescription rate of high dose methylprednisolone for acute SCI is decreasing in South Korea but it is still high.

Digital Measurements With Hallux Valgus Before and After Modified Long Oblique Osteotomy.

Radiographic measurements of the hallux valgus (HV) angle (HVA) and the first intermetatarsal angle (IMA1-2) are important for assessing the severity of HV. The purpose of the present study was to digitally investigate the intraobserver and interobserver reliability of various methods for measuring HVA and IMA1-2, as well as each axis composing them, such as axes of the first proximal phalanx (PP1), the first metatarsal (MT1), and the second metatarsal (MT2) in patients with a metatarsal shaft osteotomy-modified long oblique osteotomy. Three orthopedic surgeons measured the HVA, IMA1-2, and the angles between axes of PP1, MT1, and MT2, and the digitally-set reference line (α, ß, and γ, respectively) using 6 different methods for 39 patients with a minimum of 1 year of follow-up after operative treatment. The intraobserver and interobserver intraclass correlation coefficients (ICC) and agreements were calculated. Significant differences were observed within the methods with regard to preoperative HVA, IMA1-2, α, and ß, and postoperative IMA1-2 and ß. Intraobserver and interobserver ICC were high or very high in most methods. For HVA and IMA1-2, the method connecting the center of the head through the center of the base showed the highest agreement. For α, ß, and γ, this method showed the highest agreement, more than 80% intraobserver and interobserver agreement and a discrepancy of <2°. A digital method connecting the center of the head through the center of the base was regarded as the least variable for the HV evaluation and the assessment of the radiographic results in a metatarsal shaft osteotomy-modified long oblique osteotomy.