Rod fracture is the one of postoperative complications in posterior spinal fusion surgery for adult spinal deformity and its prevalence has been reported as 6.8-38.8%. The reoperation rate of rod fracture after spinal fusion is reported to be 41.2-87%, which is higher in patients with bilateral rod fracture (75-91%) than those with unilateral rod fracture (21-43%). Despite high reoperation rate in patients with rod fracture, especially bilateral rod fracture, the pathological mechanisms including mechanical stress change of intervertebral disc in patients with rod fracture have not been well-studied.
To clarify mechanical stress change of intervertebral disc in rod fracture model after posterior spinal fusion using 3D-CT finite element analysis (CT/FEA).
A comparative biomechanical study.
Seven patients ≥ 20 years old (3 males and 4 females) who underwent lumbar spinal surgery.
Patients’ characteristics such as age and BMI, and global spinal alignment (eg, sagittal vertical axis [SVA] and pelvic incidence minus lumbar lordosis [PI-LL]) were examined. Posterior spinal fusion models from L3 to S1 with non-rod fracture (NRF, a), unilateral rod fracture (URF, b), and bilateral rod fracture (BRF, c) at L4/5 were created using three-dimensional finite element analysis software. Forward bending loads were applied to each model, and the minimum principal stresses (MPa) of the intervertebral discs at the adjacent level (L2/3) and the rod fracture level (L4/5) were measured in each model using CT-FEA.
The minimum principal stresses of the intervertebral discs at L2/3 and L4/5 were compared among the NRF, URF, and BRF models using the Friedman's test and Bonferroni correction.
The mean age was 38.0 ± 11.2 years old and BMI was 22.4 ± 2.9 kg/m². The mean SVA was 30.4 ± 60.9 mm and the PI-LL was 6.7 ± 12.5°. No significant differences in the minimum principal stresses at L2/3 level among three models were observed (NRF, 11.0 MPa; URF, 7.5 MPa; BRF, 6.7 MPa, p=.651. At L4/5 level, no significant differences in the minimum principal stresses between the NRF and URF models or the URF and BRF models were observed; however, the minimum principal stress of the intervertebral disc at L4/5 was significantly higher in the BRF model compared to the NRF model (NRF, 0.7 MPa; BRF, 5.4 MPa, p=.001).
The mechanical stress at rod fracture level was significantly higher in bilateral rod fracture model by CT-FEA, which may contribute to the higher reoperation rate in patients with bilateral rod fracture after posterior spinal fusion surgery.
This abstract does not discuss or include any applicable devices or drugs.
This abstract has been previously published as part of the Cervical Research Society 51st Annual Meeting proceedings. For full access to the abstract, please visit the following URL: https://scholarlyworks.beaumont.org/orthopaedic_surgery_posters/16/
Fragility fractures are common in elderly patients and are associated with high mortality and functional disability. The geriatric nutritional risk index (GNRI) is an objective nutritional status assessment tool to predict mortality risk in hospitalized patients. However, whether the GNRI reflects short-term mortality in fragility fracture patients is unclear. This study aimed to examine the nutritional status assessed by the GNRI in patients with fragility fractures and identify cut-off scores that predict mortality risk.
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Elderly fragility fracture patients in our hospital from 2021 to 2023 were retrospectively studied. A total of 56 patients (19 men and 37 women, mean age 83.2 ± 6.7 years) were included. All patients were followed up for more than 3 months. Clinical data were extracted from electronic medical records. Mortality within 90 days after admission was studied. GNRI was calculated for all patients on admission as 14.89 × serum albumin (g/dL) + 41.7 × BMI / 22. Using the recipient operating characteristic (ROC) curve, the area under the curve (AUC) that can predict mortality 90 days after admission and the optimal cut-off scores were calculated.
The mean GNRI was 97.2 ± 9.2 (76.6-114.7). Three (5.2%) deaths occurred in the cohort; the ROC-AUC value was 0.85, and the cut-off GNRI was 95.6. Sensitivity and specificity were 100% and 64.2%, respectively.
Our results show that nutritional status assessment using GNRI can help predict mortality within 90 days in elderly fragility fracture patients; GNRI can be considered a simple tool to predict mortality risk in fragility fracture patients. In addition, early detection of low nutritional status may improve nutritional status before fracture, reducing mortality risk.
This abstract does not discuss or include any applicable devices or drugs.
Several studies found the age-related changes in the orientation of lumbar facet joints in Asian population. However, there is a paucity of literature on the association between orientation of the lumbar facet joints and age in white and Black population.
To explore the association between orientation of the lumbar facet joints and age in white and Black population.
A cross-sectional study.
Patients aged 20-79, who underwent abdominal and pelvic computed tomography (CT) for the trauma screening in New York City area and whose race was classified as “white” and “Black” on the questionnaire, were recruited in the study from Mar 2019 to Mar 2020.
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In total, there were 1,343 subjects included, 650 white (339 females, 311 males) and 693 Black (355 females, 338 males) patients. Subjects were recruited based on their subgroups until there was a minimum of 45 measurements at each facet joint level in each of the 24 subgroups. The subgroups were based on gender, race, and 10-year age range. Facet joint orientation angle of both sides was measured and averaged at L1/2, L2/3, L3/4, L4/5, and L5/S1 in the axial planes on CT images. Associations between the angle and age were analyzed.
Facet joint angles significantly increased with aging at L1/2 in white population and decreased at all the levels in Black population (p<0.05). Facet joint angles significantly increased with aging at L1/2 in white females and decreased at all the levels in Black females (p<0.05). Facet joint angles significantly increased with aging at L1/2 in white males and decreased with aging at L1/2, L2/3, L3/4, and L4/5 in Black males (p<0.05). At L4/5, age-related decrease was most remarkable in Black females and the angle was the smallest in 70 years of age in Black females.
Lumbar facet joint angles significantly decreased with aging in Black females and males, while not in white females or males. At L4/5, decreasing facet joint angles with aging was most remarkable in Black females. Our results may explain the high prevalence of degenerative spondylolisthesis at L4/5 in Black females.
This abstract does not discuss or include any applicable devices or drugs.
This abstract was previously published in the 2023 Spineweek proceedings. For access to the original publication, please visit the following URL: https://www.sosort.org/resources/Documents/Spineweek_2023_oral_abstracts_final-1.pdf.
Surgical intervention for degenerative cervical myelopathy (DCM) is intended to improve or prevent further decline in the patient's physical function and overall quality of life (QOL). Despite improvements in both myelopathy and QOL post-surgery, many patients express dissatisfaction due to the persistence of severe residual paresthesia.
This study seeks to determine the frequency of residual paresthesia following DCM surgery and to evaluate its impact on clinical outcomes and patient satisfaction.
A multi-center, prospective cohort study
The study included 187 patients who underwent laminoplasty for DCM.
Assessed measures included preoperative factors, variations in clinical scores (JOA scores, VAS of upper extremity paresthesia, VAS of neck pain, NDI, EQ-5D-5l, and JOACMEQ), radiographic parameters (cervical sagittal vertical axis, C2-C7 angle, and C2-7 range of motion), and a 5-level satisfaction scale at 1 year postoperatively.
Participants were categorized into two groups based on their VAS scores for upper extremity paresthesia at 1-year post-surgery: severe paresthesia (>40 mm) and no/mild paresthesia (≤40 mm). Comparative analysis of preoperative factors, changes in clinical scores and radiographic factors, and satisfaction levels at 1-year post-surgery was performed between the groups.
Out of 187 patients, 86 experienced severe residual paresthesia 1-year postoperatively. Preoperative pain scale scores were significantly linked to postoperative residual paresthesia, independent of age, initial paresthesia severity, and other preoperative clinical scores (p=0.032). Mixed-effect modeling indicated that patients with severe residual paresthesia showed significantly less improvement in QOL (p=0.046) and myelopathy (p=0.037) compared to those with no/mild paresthesia. Logistic regression revealed that residual paresthesia was a significant predictor of lower treatment satisfaction, independent of myelopathy and QOL improvements (adjusted odds ratio: 2.5, p=0.010).
At one year postoperatively, 45% of DCM patients exhibited severe residual paresthesia, correlating with significantly lower satisfaction with their treatment despite improvements in myelopathy and QOL. These findings suggest that a multidisciplinary approach addressing residual paresthesia, including pharmacological management of neuropathic pain, may be essential for improving patient outcomes.
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