Introduction: Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.
Methods: We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.
Results: We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.
Conclusions: This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.
{"title":"Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study.","authors":"Hiroki Takeda, Takehiro Michikawa, Sota Nagai, Soya Kawabata, Kei Ito, Daiki Ikeda, Nobuyuki Fujita, Shinjiro Kaneko","doi":"10.22603/ssrr.2023-0191","DOIUrl":"10.22603/ssrr.2023-0191","url":null,"abstract":"<p><strong>Introduction: </strong>Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.</p><p><strong>Methods: </strong>We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.</p><p><strong>Results: </strong>We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.</p><p><strong>Conclusions: </strong>This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply to the Editor Regarding the Article: A Modified Spinal Reconstruction Method Reduces Instrumentation Failure in Total En Bloc Spondylectomy for Spinal Tumors.","authors":"Satoshi Kato, Satoru Demura, Kazuya Shinmura, Noriaki Yokogawa, Hideki Murakami","doi":"10.22603/ssrr.2023-0216","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0216","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor Concerning \"A Modified Spinal Reconstruction Method Reduces Instrumentation Failure in Total En Bloc Spondylectomy for Spinal Tumors,\" by Shinmura et al.","authors":"Shun Umeki, Tadatsugu Morimoto, Hirohito Hirata, Masaaki Mawatari","doi":"10.22603/ssrr.2023-0107","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0107","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
[This corrects the article DOI: 10.22603/ssrr.2023-0021.].
[这更正了文章DOI:10.22603/ssrr.2023-0021]。
{"title":"Erratum for A Novel Technique for Pars Defect Direct Repair with a Modified Smiley Face Rod for Spondylolysis and Isthmic Spondylolisthesis.","authors":"Masaki Tatsumura, Shun Okuwaki, Hisarnori Gamada, Reo Asai, Fumihiko Eto, Katsuya Nagashima, Yosuke Takeuchi, Toru Funayama, Masashi Yamazaki","doi":"10.22603/ssrr.2023-0021-er","DOIUrl":"10.22603/ssrr.2023-0021-er","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.22603/ssrr.2023-0021.].</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/6c/2432-261X-7-0473.PMC10569805.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04eCollection Date: 2023-11-27DOI: 10.22603/ssrr.2023-0013
Paulo Daniel Sousa Santa Cruz, Michel Kanas, Marcelo Wajchenberg
Introduction: Football soccer practice involves considerable risks of lesions, making it difficult to strike a balance between adequate preparation and the demand imposed on athletes. A high incidence of postural disorders among adolescents leads to questions about the influence of sports activity on the athletes' posture and sagittal balance.
Methods: A cross-sectional study was conducted from panoramic spine radiographs of 110 professional Brazilian football (soccer) players. They were male and aged between 20 and 30 years. Measurements of pelvic incidence, pelvic tilt (PT), sacral slope, sagittal vertical axis (SVA), and lumbar lordosis were obtained by using the SurgimapⓇ software. Measurement values were compared with the Brazilian literature data. Lordosis type was categorized according to the classification of Roussouly et al., and the presence of spondylolysis and spondylolisthesis was analyzed.
Results: Findings indicated that (1) among 110 radiographs analyzed, 104 had appropriate measurement quality; (2) values compared with the Brazilian mean demonstrated that PT and SVA were statistically lower in professional players (P=0.013 and P=0.037, respectively); (3) according to Roussouly et al. most participants presented Type 3 lordosis (54.8%), followed by Type 4 (26.9%); (4) eight athletes (7.7%) had spondylolysis, and among them, seven (6.7%) had spondylolisthesis.
Conclusions: Significant differences in PT and SVA were found in professional athletes. The most common type of lordosis was the same as that found in the general population (Type 3), and the incidence of spondylolysis and spondylolisthesis was higher than that found in the general population, but lower than that found in football (soccer) players.
{"title":"Sagittal Balance in Professional Brazilian Football Players.","authors":"Paulo Daniel Sousa Santa Cruz, Michel Kanas, Marcelo Wajchenberg","doi":"10.22603/ssrr.2023-0013","DOIUrl":"10.22603/ssrr.2023-0013","url":null,"abstract":"<p><strong>Introduction: </strong>Football soccer practice involves considerable risks of lesions, making it difficult to strike a balance between adequate preparation and the demand imposed on athletes. A high incidence of postural disorders among adolescents leads to questions about the influence of sports activity on the athletes' posture and sagittal balance.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from panoramic spine radiographs of 110 professional Brazilian football (soccer) players. They were male and aged between 20 and 30 years. Measurements of pelvic incidence, pelvic tilt (PT), sacral slope, sagittal vertical axis (SVA), and lumbar lordosis were obtained by using the Surgimap<sup>Ⓡ</sup> software. Measurement values were compared with the Brazilian literature data. Lordosis type was categorized according to the classification of Roussouly et al., and the presence of spondylolysis and spondylolisthesis was analyzed.</p><p><strong>Results: </strong>Findings indicated that (1) among 110 radiographs analyzed, 104 had appropriate measurement quality; (2) values compared with the Brazilian mean demonstrated that PT and SVA were statistically lower in professional players (P=0.013 and P=0.037, respectively); (3) according to Roussouly et al. most participants presented Type 3 lordosis (54.8%), followed by Type 4 (26.9%); (4) eight athletes (7.7%) had spondylolysis, and among them, seven (6.7%) had spondylolisthesis.</p><p><strong>Conclusions: </strong>Significant differences in PT and SVA were found in professional athletes. The most common type of lordosis was the same as that found in the general population (Type 3), and the incidence of spondylolysis and spondylolisthesis was higher than that found in the general population, but lower than that found in football (soccer) players.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Low-back pain causes sleep disorders, which impairs the quality of life (QOL) of patients. Sleep disorders are associated with lumbar spinal stenosis (LSS); however, the postoperative effects of LSS surgery on sleep disorders are unknown. This study aimed to assess sleep disorders in patients with LSS using wearable activity trackers and determine whether surgery improves sleep quality.
Methods: A total of 39 patients scheduled for LSS surgery (mean age 71.1±8.7 years; 22 men and 17 women) were studied. Sleep disorders in the participants were objectively evaluated using a wearable Motionlogger Micro system. Sleep efficiency (SEf), mean active count (MAC), and wake after sleep onset (WASO) were measured before and 6 months following surgery. Furthermore, the patient-based outcomes of pain and QOL-related scores were measured and compared with those of healthy participants. The group with improved SEf following surgery was designated as "nonpoor sleepers," whereas the group that did not exhibit improvements was designated as "poor sleepers." The two groups were compared based on patient factors, patient-based questionnaires, and sleep disorder measurements.
Results: The SEf and WASO were significantly worse in patients with LSS compared with healthy participants (P<0.05). Furthermore, the SEf in patients with LSS was associated with the Oswestry Disability Index scores. No improvement was observed in the SEf, MAC, and WASO before and after surgery. Evaluation of each case revealed 21 and 12 cases of nonpoor and poor sleepers, respectively. Preoperative low-back pain was significantly associated with improvement in postoperative sleep quality.
Conclusions: Sleep disorders in patients with LSS were evaluated, and improvement in sleep disorders following surgery was associated with the intensity of preoperative low-back pain. Sleep disorders are associated with QOL disorders, suggesting that focusing on the treatment of sleep disorders is important in the management of patients with LSS.
{"title":"Objective Assessment of Sleep Disorders in Patients with Lumbar Spinal Stenosis Using Wearable Trackers.","authors":"Masahiro Inoue, Sumihisa Orita, Kazuhide Inage, Miyako Suzuki-Narita, Yasuhiro Shiga, Hideyuki Kinoshita, Masaki Norimoto, Tomotaka Umimura, Yawara Eguchi, Tsutomu Akazawa, Yasuchika Aoki, Yuki Shiko, Masahiko Suzuki, Yohei Kawasaki, Seiji Ohtori","doi":"10.22603/ssrr.2023-0116","DOIUrl":"10.22603/ssrr.2023-0116","url":null,"abstract":"<p><strong>Introduction: </strong>Low-back pain causes sleep disorders, which impairs the quality of life (QOL) of patients. Sleep disorders are associated with lumbar spinal stenosis (LSS); however, the postoperative effects of LSS surgery on sleep disorders are unknown. This study aimed to assess sleep disorders in patients with LSS using wearable activity trackers and determine whether surgery improves sleep quality.</p><p><strong>Methods: </strong>A total of 39 patients scheduled for LSS surgery (mean age 71.1±8.7 years; 22 men and 17 women) were studied. Sleep disorders in the participants were objectively evaluated using a wearable Motionlogger Micro system. Sleep efficiency (SEf), mean active count (MAC), and wake after sleep onset (WASO) were measured before and 6 months following surgery. Furthermore, the patient-based outcomes of pain and QOL-related scores were measured and compared with those of healthy participants. The group with improved SEf following surgery was designated as \"nonpoor sleepers,\" whereas the group that did not exhibit improvements was designated as \"poor sleepers.\" The two groups were compared based on patient factors, patient-based questionnaires, and sleep disorder measurements.</p><p><strong>Results: </strong>The SEf and WASO were significantly worse in patients with LSS compared with healthy participants (<i>P</i><0.05). Furthermore, the SEf in patients with LSS was associated with the Oswestry Disability Index scores. No improvement was observed in the SEf, MAC, and WASO before and after surgery. Evaluation of each case revealed 21 and 12 cases of nonpoor and poor sleepers, respectively. Preoperative low-back pain was significantly associated with improvement in postoperative sleep quality.</p><p><strong>Conclusions: </strong>Sleep disorders in patients with LSS were evaluated, and improvement in sleep disorders following surgery was associated with the intensity of preoperative low-back pain. Sleep disorders are associated with QOL disorders, suggesting that focusing on the treatment of sleep disorders is important in the management of patients with LSS.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case of Neurofibromatosis 1 with Myelopathy Due to Intracanal Rib Head and Kyphoscoliosis in an Adult.","authors":"Takuji Yamamoto, Yohshiro Nitobe, Kanichiro Wada, Gentaro Kumagai, Toru Asari, Kotaro Aburakawa, Yasuyuki Ishibashi","doi":"10.22603/ssrr.2023-0087","DOIUrl":"10.22603/ssrr.2023-0087","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04eCollection Date: 2024-01-27DOI: 10.22603/ssrr.2023-0094
Austen D Katz, Junho Song, Priya Duvvuri, Alex Ngan, Terence Ng, Sayyida Hasan, Sohrab Virk, Jeff Silber, David Essig
Introduction: While there is anecdotal evidence that the coronavirus disease 2019 (COVID-19) pandemic altered perioperative decision-making in patients requiring posterior cervical fusion (PCF), a national-level analysis to examine the significance of this hypothesis has not yet been conducted. This study aimed to determine the potential differences in perioperative variables and surgical outcomes of PCF performed before vs. during the COVID-19 pandemic.
Methods: Adults who underwent PCF were identified in the 2019 (prepandemic) and 2020 (intrapandemic) NSQIP datasets. Differences in 30-day readmission, reoperation, and morbidity were evaluated using multivariate logistic regression. On the other hand, differences in operative time and relative value units (RVUs) were estimated using quantile regression. Furthermore, the odds ratios (OR) for length of stay (LOS) were estimated using negative binomial regression. Secondary outcomes included rates of nonhome discharge and outpatient surgery.
Results: A total of 3,444 patients were included in this study (50.7% from 2020). Readmission, reoperation, morbidity, operative time, and RVUs per minute were similar between cohorts (p>0.05). The LOS (OR 1.086, p<0.001) and RVUs-per-case (coefficient +0.360, p=0.037) were significantly greater in 2020 compared to 2019. Operation year 2020 was also associated with lower rates of nonhome discharge (22.3% vs. 25.8%, p=0.017) and higher rates of outpatient surgery (4.8% vs. 3.0%, p=0.006).
Conclusions: During the COVID-19 pandemic, a 28% decreased odds of nonhome discharge following PCF and a 72% increased odds of PCF being performed in an outpatient setting were observed. The readmission, reoperation, and morbidity rates remained unchanged during this period. This is notable given that patients in the 2020 group were more frail. This suggests that patients were shifted to outpatient centers possibly to make up for potentially reduced case volume, highlighting the potential to evaluate rehabilitation-discharge criteria. Further research should evaluate these findings in more detail and on a regional basis.
{"title":"Impact of the COVID-19 Pandemic on Outcomes and Perioperative Factors Associated with Posterior Cervical Fusion.","authors":"Austen D Katz, Junho Song, Priya Duvvuri, Alex Ngan, Terence Ng, Sayyida Hasan, Sohrab Virk, Jeff Silber, David Essig","doi":"10.22603/ssrr.2023-0094","DOIUrl":"10.22603/ssrr.2023-0094","url":null,"abstract":"<p><strong>Introduction: </strong>While there is anecdotal evidence that the coronavirus disease 2019 (COVID-19) pandemic altered perioperative decision-making in patients requiring posterior cervical fusion (PCF), a national-level analysis to examine the significance of this hypothesis has not yet been conducted. This study aimed to determine the potential differences in perioperative variables and surgical outcomes of PCF performed before vs. during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Adults who underwent PCF were identified in the 2019 (prepandemic) and 2020 (intrapandemic) NSQIP datasets. Differences in 30-day readmission, reoperation, and morbidity were evaluated using multivariate logistic regression. On the other hand, differences in operative time and relative value units (RVUs) were estimated using quantile regression. Furthermore, the odds ratios (OR) for length of stay (LOS) were estimated using negative binomial regression. Secondary outcomes included rates of nonhome discharge and outpatient surgery.</p><p><strong>Results: </strong>A total of 3,444 patients were included in this study (50.7% from 2020). Readmission, reoperation, morbidity, operative time, and RVUs per minute were similar between cohorts (<i>p</i>>0.05). The LOS (OR 1.086, <i>p</i><0.001) and RVUs-per-case (coefficient +0.360, <i>p</i>=0.037) were significantly greater in 2020 compared to 2019. Operation year 2020 was also associated with lower rates of nonhome discharge (22.3% vs. 25.8%, <i>p</i>=0.017) and higher rates of outpatient surgery (4.8% vs. 3.0%, <i>p</i>=0.006).</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic, a 28% decreased odds of nonhome discharge following PCF and a 72% increased odds of PCF being performed in an outpatient setting were observed. The readmission, reoperation, and morbidity rates remained unchanged during this period. This is notable given that patients in the 2020 group were more frail. This suggests that patients were shifted to outpatient centers possibly to make up for potentially reduced case volume, highlighting the potential to evaluate rehabilitation-discharge criteria. Further research should evaluate these findings in more detail and on a regional basis.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spinal cord injury (SCI) is a devastating injury that causes permanent neurological dysfunction. To develop a new treatment strategy for SCI, a clinical trial of transplantation of human-induced pluripotent stem cell-derived neural precursor cells (NPCs) in patients in the subacute phase of SCI was recently initiated. The formation of synaptic connections with host neural tissues is one of the therapeutic mechanisms of cell transplantation, and this beneficial efficacy has been directly demonstrated using a chemogenetic tool. This research focuses on the establishment of cell therapy for chronic SCI, which is more challenging owing to cavity and scar formation. Thus, neurogenic NPC transplantation is more effective in forming functional synapses with the host neurons. Furthermore, combinatory rehabilitation therapy is useful to enhance the efficacy of this strategy, and a valid rehabilitative training program has been established for SCI animal models that received NPC transplantation in the chronic phase. Therefore, the use of regenerative medicine for chronic SCI is expected to increase.
{"title":"Regenerative Medicine for Spinal Cord Injury Using Induced Pluripotent Stem Cells.","authors":"Narihito Nagoshi, Keiko Sugai, Hideyuki Okano, Masaya Nakamura","doi":"10.22603/ssrr.2023-0135","DOIUrl":"10.22603/ssrr.2023-0135","url":null,"abstract":"<p><p>Spinal cord injury (SCI) is a devastating injury that causes permanent neurological dysfunction. To develop a new treatment strategy for SCI, a clinical trial of transplantation of human-induced pluripotent stem cell-derived neural precursor cells (NPCs) in patients in the subacute phase of SCI was recently initiated. The formation of synaptic connections with host neural tissues is one of the therapeutic mechanisms of cell transplantation, and this beneficial efficacy has been directly demonstrated using a chemogenetic tool. This research focuses on the establishment of cell therapy for chronic SCI, which is more challenging owing to cavity and scar formation. Thus, neurogenic NPC transplantation is more effective in forming functional synapses with the host neurons. Furthermore, combinatory rehabilitation therapy is useful to enhance the efficacy of this strategy, and a valid rehabilitative training program has been established for SCI animal models that received NPC transplantation in the chronic phase. Therefore, the use of regenerative medicine for chronic SCI is expected to increase.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68231072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04eCollection Date: 2024-01-27DOI: 10.22603/ssrr.2023-0113
Abdullah Ghali, David Momtaz, Travis Kotzur, Rishi Gonuguntla, Rebecca Wang, Alan C Santiago-Rodriquez, Eileen N Phan, Ali Seifi, Darrell Hanson
Introduction: Leaving against medical advice (AMA) has been associated with higher rates of readmission and worse postoperative outcomes in various surgical fields. Patients who have undergone spine surgery often require careful postoperative follow-up to ensure an uncomplicated recovery. In this study, we aim to investigate the demographic and hospital variables that may have contributed to patients leaving the hospital AMA following spine surgery.
Methods: We performed a retrospective analysis of patients receiving spine surgery; we used the data from the Healthcare Cost and Utilization Project (HCUP) database for the years 2011-2020. Demographics, household income status, insurance status, time from admission to operation, length of stay, length of recovery, and discharge disposition were collected and analyzed. Multivariate linear regression was used to determine the odds ratios of each factor and their association to patient decision of leaving AMA.
Results: As per our findings, patients aged 30-49 had 1.666 times greater odds of leaving AMA following spine surgery (P<0.001), patients aged 50-64 had 1.222 times greater odds of leaving AMA (P=0.001), and patients older than 65 had 0.490 times lesser odds of leaving AMA (P<0.001). Additionally, black patients were 1.612 times more likely to leave AMA (P<0.001), whereas white patients were 0.675 times less likely to do so (<0.001). Women were 0.555 times less likely to leave AMA than the rest of the population (P<0.001). Moreover, patients with private insurance were 0.268 times less likely to leave AMA (P<0.001), while patients on Medicare and Medicaid were 1.692 times (P<0.001) and 3.958 times more likely to leave AMA (P<0.001) following spine surgery, respectively. Finally, patients in the lowest quartile of income were 1.691 times more likely to leave AMA (P<0.001), while patients in the higher quartile of income were 0.521 times less likely to do so (P<0.001).
Conclusions: It is critical that spine surgeons are aware of the factors that predispose patients to leave AMA in order to mitigate postoperative complications.
导言:在各种外科领域,违抗医嘱(AMA)与较高的再入院率和较差的术后效果有关。接受脊柱手术的患者通常需要仔细的术后随访,以确保顺利康复。在本研究中,我们旨在调查可能导致患者在脊柱手术后离开医院的人口统计学和医院变量:我们对接受脊柱手术的患者进行了回顾性分析;我们使用了医疗成本与利用项目(HCUP)数据库中 2011-2020 年的数据。我们收集并分析了人口统计学、家庭收入状况、保险状况、从入院到手术的时间、住院时间、恢复时间和出院处置。采用多变量线性回归法确定各因素的几率及其与患者决定离开 AMA 的关系:结果:根据我们的研究结果,30-49 岁的患者在脊柱手术后离开美国医学会的几率是 30-49 岁患者的 1.666 倍(PC 结论:脊柱外科医生对脊柱手术的认识至关重要:脊柱外科医生必须了解导致患者离开 AMA 的因素,以减少术后并发症。
{"title":"Rates and Characteristics of Patients Leaving against Medical Advice after Spine Surgery.","authors":"Abdullah Ghali, David Momtaz, Travis Kotzur, Rishi Gonuguntla, Rebecca Wang, Alan C Santiago-Rodriquez, Eileen N Phan, Ali Seifi, Darrell Hanson","doi":"10.22603/ssrr.2023-0113","DOIUrl":"10.22603/ssrr.2023-0113","url":null,"abstract":"<p><strong>Introduction: </strong>Leaving against medical advice (AMA) has been associated with higher rates of readmission and worse postoperative outcomes in various surgical fields. Patients who have undergone spine surgery often require careful postoperative follow-up to ensure an uncomplicated recovery. In this study, we aim to investigate the demographic and hospital variables that may have contributed to patients leaving the hospital AMA following spine surgery.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients receiving spine surgery; we used the data from the Healthcare Cost and Utilization Project (HCUP) database for the years 2011-2020. Demographics, household income status, insurance status, time from admission to operation, length of stay, length of recovery, and discharge disposition were collected and analyzed. Multivariate linear regression was used to determine the odds ratios of each factor and their association to patient decision of leaving AMA.</p><p><strong>Results: </strong>As per our findings, patients aged 30-49 had 1.666 times greater odds of leaving AMA following spine surgery (P<0.001), patients aged 50-64 had 1.222 times greater odds of leaving AMA (P=0.001), and patients older than 65 had 0.490 times lesser odds of leaving AMA (P<0.001). Additionally, black patients were 1.612 times more likely to leave AMA (P<0.001), whereas white patients were 0.675 times less likely to do so (<0.001). Women were 0.555 times less likely to leave AMA than the rest of the population (P<0.001). Moreover, patients with private insurance were 0.268 times less likely to leave AMA (P<0.001), while patients on Medicare and Medicaid were 1.692 times (P<0.001) and 3.958 times more likely to leave AMA (P<0.001) following spine surgery, respectively. Finally, patients in the lowest quartile of income were 1.691 times more likely to leave AMA (P<0.001), while patients in the higher quartile of income were 0.521 times less likely to do so (P<0.001).</p><p><strong>Conclusions: </strong>It is critical that spine surgeons are aware of the factors that predispose patients to leave AMA in order to mitigate postoperative complications.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}