Precise ASIA Impairment Scale (AIS) prediction at discharge for spinal cord injury (SCI) patients is crucial for guiding treatments, indicating regenerative medicine, and rehabilitation. Machine learning (ML) models are promising to improve such prognostic accuracy and aid clinical decisions.
PURPOSE
We aimed to create an ML model that predicts discharge AIS, to identify predictive factors, and to integrate this model into a web application.
STUDY DESIGN/SETTING
A retrospective cohort study.
PATIENT SAMPLE
This study used data from a nationwide database in Japan, the Japan Rehabilitation Database (JARD), consisting of records from 1991 to 2015. JARD contains both the SCI patients admitted to the SCI center right after the injury and the SCI patients referred to a rehabilitation hospital following acute phase treatment. In total, 3,703 cases formed the study cohort.
OUTCOME MEASURES
N/A
METHODS
Patient demographics, SCI-specific characteristics, and neurological evaluations at admission were used for ML model training. Utilizing the PyCaret library for preprocessing and validating the models, the best-performing algorithm was selected based on R², accuracy, and the weighted Kappa coefficient. Shapley additive explanations (SHAP) were used to determine the contribution of individual variables to the model's predictions. Using the optimal ML model and Streamlit, a web application to predict AIS at discharge was deployed.
RESULTS
The study divided the dataset into 2,592 training cases and 1,111 testing cases. The best-performing model exhibited an R² of 0.869, an accuracy of 0.814, and a weighted Kappa of 0.940. Eleven significant variables were identified with SHAP, including AIS at admission, days from injury to admission, and the motor score of L3. Using the Streamlit library, this best-performing model was deployed as an open-access web application. (http://3.138.174.54:8502/)
CONCLUSIONS
The developed ML model accurately predicts the AIS at discharge, using 11 essential variables. It has been integrated into a publicly accessible web application.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"7. Development of a web application for predicting Asia Impairment Scale at discharge in spinal cord injury patients: a machine learning approach","authors":"Kyota Kitagawa MD , Satoshi Maki MD, PhD , Takeo Furuya MD, PhD , Juntaro Maruyama MD , Yasunori Toki MD , Seiji Ohtori MD, PhD","doi":"10.1016/j.xnsj.2024.100345","DOIUrl":"10.1016/j.xnsj.2024.100345","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Precise ASIA Impairment Scale (AIS) prediction at discharge for spinal cord injury (SCI) patients is crucial for guiding treatments, indicating regenerative medicine, and rehabilitation. Machine learning (ML) models are promising to improve such prognostic accuracy and aid clinical decisions.</p></div><div><h3>PURPOSE</h3><p>We aimed to create an ML model that predicts discharge AIS, to identify predictive factors, and to integrate this model into a web application.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>This study used data from a nationwide database in Japan, the Japan Rehabilitation Database (JARD), consisting of records from 1991 to 2015. JARD contains both the SCI patients admitted to the SCI center right after the injury and the SCI patients referred to a rehabilitation hospital following acute phase treatment. In total, 3,703 cases formed the study cohort.</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Patient demographics, SCI-specific characteristics, and neurological evaluations at admission were used for ML model training. Utilizing the PyCaret library for preprocessing and validating the models, the best-performing algorithm was selected based on R², accuracy, and the weighted Kappa coefficient. Shapley additive explanations (SHAP) were used to determine the contribution of individual variables to the model's predictions. Using the optimal ML model and Streamlit, a web application to predict AIS at discharge was deployed.</p></div><div><h3>RESULTS</h3><p>The study divided the dataset into 2,592 training cases and 1,111 testing cases. The best-performing model exhibited an R² of 0.869, an accuracy of 0.814, and a weighted Kappa of 0.940. Eleven significant variables were identified with SHAP, including AIS at admission, days from injury to admission, and the motor score of L3. Using the Streamlit library, this best-performing model was deployed as an open-access web application. (<span><span>http://3.138.174.54:8502/</span><svg><path></path></svg></span>)</p></div><div><h3>CONCLUSIONS</h3><p>The developed ML model accurately predicts the AIS at discharge, using 11 essential variables. It has been integrated into a publicly accessible web application.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000386/pdfft?md5=d34e96581a3d3ea707979096af6848aa&pid=1-s2.0-S2666548424000386-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954600","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}
Epidural adhesiolytic therapy using a steerable catheter has been covered by insurance in Japan since April 2018, but there is a lack of reports radiologically evaluating its therapeutic effects, leading to uncertainty.
PURPOSE
In this study, we investigated how the depiction of runoff pattern contrast (RPC) in intraoperative imaging (radiculography) affects treatment outcomes and report our findings.
STUDY DESIGN/SETTING
A single-center observational study.
PATIENT SAMPLE
A total of 188 cases, consisting of 89 males and 99 females with a mean age of 72.9 years, who underwent epidural adhesiolysis for complaints of lower back pain and leg pain from August 2018 to December 2021. Targeted conditions included lumbar spinal stenosis, intervertebral disc herniation, lumbar spondylolisthesis, nonspecific lower back pain, sacral cyst, failed back surgery syndrome, and multiple operation back.
OUTCOME MEASURES
Improvement rate based on the Visual Analog Scale (VAS).
METHODS
Evaluation criteria included the presence of early postoperative (1 week) symptom improvement, VAS improvement rates of 50% or more at 6 months and 1 year as effective, and comparison with the presence of RPC in intraoperative contrast radiography.
RESULTS
Early postoperatively, 122 cases (65%) reported subjective symptom improvement (P < 0.05), with RPC in 67 cases (55%). At 6 months, 78 cases (42%) showed effectiveness, including RPC in 53 cases (69%). After 1 year, 58 cases (31%) demonstrated effectiveness, with RPC in 47 cases (82%). Additionally, among the 41 cases (21.8%) that required surgery, RPC was absent.
CONCLUSIONS
The effectiveness of epidural adhesiolysis is not persistent and is often limited to a specific period. Our results suggest the potential impact of RPC on long-term outcomes, indicating the possibility of predicting treatment effectiveness based on intraoperative contrast imaging findings.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"46. Effect of runoff pattern contrast (RPC) on the long-term outcomes of epidural adhesiolysis using steerable catheters: a single-center observational study","authors":"Morito Shinji PhD , Atsushi Matsuo MD , Kakizoe Mizuki , Futami Suguto","doi":"10.1016/j.xnsj.2024.100384","DOIUrl":"10.1016/j.xnsj.2024.100384","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Epidural adhesiolytic therapy using a steerable catheter has been covered by insurance in Japan since April 2018, but there is a lack of reports radiologically evaluating its therapeutic effects, leading to uncertainty.</p></div><div><h3>PURPOSE</h3><p>In this study, we investigated how the depiction of runoff pattern contrast (RPC) in intraoperative imaging (radiculography) affects treatment outcomes and report our findings.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A single-center observational study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 188 cases, consisting of 89 males and 99 females with a mean age of 72.9 years, who underwent epidural adhesiolysis for complaints of lower back pain and leg pain from August 2018 to December 2021. Targeted conditions included lumbar spinal stenosis, intervertebral disc herniation, lumbar spondylolisthesis, nonspecific lower back pain, sacral cyst, failed back surgery syndrome, and multiple operation back.</p></div><div><h3>OUTCOME MEASURES</h3><p>Improvement rate based on the Visual Analog Scale (VAS).</p></div><div><h3>METHODS</h3><p>Evaluation criteria included the presence of early postoperative (1 week) symptom improvement, VAS improvement rates of 50% or more at 6 months and 1 year as effective, and comparison with the presence of RPC in intraoperative contrast radiography.</p></div><div><h3>RESULTS</h3><p>Early postoperatively, 122 cases (65%) reported subjective symptom improvement (P < 0.05), with RPC in 67 cases (55%). At 6 months, 78 cases (42%) showed effectiveness, including RPC in 53 cases (69%). After 1 year, 58 cases (31%) demonstrated effectiveness, with RPC in 47 cases (82%). Additionally, among the 41 cases (21.8%) that required surgery, RPC was absent.</p></div><div><h3>CONCLUSIONS</h3><p>The effectiveness of epidural adhesiolysis is not persistent and is often limited to a specific period. Our results suggest the potential impact of RPC on long-term outcomes, indicating the possibility of predicting treatment effectiveness based on intraoperative contrast imaging findings.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000775/pdfft?md5=ba474e65837ad2a1bd210564b65561e8&pid=1-s2.0-S2666548424000775-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850546","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 : 2024-07-01DOI: 10.1016/j.xnsj.2024.100407
Ankit Indravadan Mehta MD , Kornelis A. Poelstra MD, PhD , Michael S. Chang MD
This abstract has been previously published as part of the 2024 International Meeting on Advanced Spine Techniques proceedings. For access to the original publication, please visit the following URL: https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf.
{"title":"P3. 4.5 mm Molybdenum-Rhenium (MoRe®) rods in complex adult spine surgery without rod fractures: 2-year follow-up multicenter retrospective review","authors":"Ankit Indravadan Mehta MD , Kornelis A. Poelstra MD, PhD , Michael S. Chang MD","doi":"10.1016/j.xnsj.2024.100407","DOIUrl":"10.1016/j.xnsj.2024.100407","url":null,"abstract":"<div><p>This abstract has been previously published as part of the 2024 International Meeting on Advanced Spine Techniques proceedings. For access to the original publication, please visit the following URL: <span><span>https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100407"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001008/pdfft?md5=cdbd81ff0724107c6a07266e7d798c04&pid=1-s2.0-S2666548424001008-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846776","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 : 2024-07-01DOI: 10.1016/j.xnsj.2024.100413
Norihiko Sumiyoshi MD, PhD
<div><h3>Background Context</h3><p>Balloon kyphoplasty (BKP) is a low invasive and effective treatment for pseudarthrosis in the vertebral body after osteoporotic vertebral fracture. However, a major problem in many cases is adjacent vertebral fracture (AVF). The cause of AVF is still unclear.</p></div><div><h3>Purpose</h3><p>The aim of this study was to analyze the risk factors of AVF after BKP.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>Eighty-seven patients had BKP for pseudarthrosis after vertebral body fracture in our institution from 2015 May to 2023 June. We retrospectively investigated 68 patients (23 males, 45 females) who had only single-level BKP for levels >L2 and were followed up for >6 months after surgery. We excluded patients who had BKP with other surgery and BKP of <L3. The average age at surgery was 77.5 years old, and the average follow-up period was 13.4 months.</p></div><div><h3>Outcome Measures</h3><p>Data were analyzed using the Mann-Whitney U test.</p></div><div><h3>Methods</h3><p>We divided the patients into two groups: Group A (n = 23) had AVF after BKP during follow-up, and Group B (n = 45) had no additional AVF after BKP. We compared the risk factors between groups. Before BKP, we investigated duration from onset to BKP, body mass index (BMI), young adult mean (YAM) in the lumbar spine and femoral neck. As preoperative radiographic findings, we investigated the area of intra-vertebral cleft, the intravertebral body instability and the height of vertebral body. The area ratio of the major psoas muscle/vertebral body, back muscles (multifidus muscle, longissimus muscle, iliocostal muscle)/vertebral body was investigated. The area ratios were measured at the craniad L4 vertebral body end-plate level in axial CT images and regarded the ratio as the amount of each muscle. The area of fat and muscle in the major psoas and back muscles were investigated to clarify the quality of the trunk muscle. The area in which Hounsfield Unit was -100 to -50 and 30 to 120 were regarded as the area of fat and muscle in the major psoas and back muscles at L4 vertebral body end-plate level in axial CT images. The amount of PMMA used for BKP and difference of vertebral body height after BKP were also investigated.</p></div><div><h3>Results</h3><p>Significant difference was observed only in the area ratio of the back muscles/L4 vertebral body (average: 1.40 in Group A and 1.95 in Group B; p<.01). However, other factors, including the area ratio of the major psoas muscle /L4 vertebral body, have no significant difference between groups. In Group A, the area of fat in major psoas and back muscles were increased compared with Group B, and two patients who had AVF despite the higher area ratio of back muscles had low muscle quality. In Group B, 6 patients who had no additional AVF despite the lower area ratio of muscle had high muscle quality.</p></div><div><h3>CONCLUSION
{"title":"P9. Analysis of risk factors of adjacent vertebral fracture after balloon kyphoplasty including trunk muscles","authors":"Norihiko Sumiyoshi MD, PhD","doi":"10.1016/j.xnsj.2024.100413","DOIUrl":"10.1016/j.xnsj.2024.100413","url":null,"abstract":"<div><h3>Background Context</h3><p>Balloon kyphoplasty (BKP) is a low invasive and effective treatment for pseudarthrosis in the vertebral body after osteoporotic vertebral fracture. However, a major problem in many cases is adjacent vertebral fracture (AVF). The cause of AVF is still unclear.</p></div><div><h3>Purpose</h3><p>The aim of this study was to analyze the risk factors of AVF after BKP.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>Eighty-seven patients had BKP for pseudarthrosis after vertebral body fracture in our institution from 2015 May to 2023 June. We retrospectively investigated 68 patients (23 males, 45 females) who had only single-level BKP for levels >L2 and were followed up for >6 months after surgery. We excluded patients who had BKP with other surgery and BKP of <L3. The average age at surgery was 77.5 years old, and the average follow-up period was 13.4 months.</p></div><div><h3>Outcome Measures</h3><p>Data were analyzed using the Mann-Whitney U test.</p></div><div><h3>Methods</h3><p>We divided the patients into two groups: Group A (n = 23) had AVF after BKP during follow-up, and Group B (n = 45) had no additional AVF after BKP. We compared the risk factors between groups. Before BKP, we investigated duration from onset to BKP, body mass index (BMI), young adult mean (YAM) in the lumbar spine and femoral neck. As preoperative radiographic findings, we investigated the area of intra-vertebral cleft, the intravertebral body instability and the height of vertebral body. The area ratio of the major psoas muscle/vertebral body, back muscles (multifidus muscle, longissimus muscle, iliocostal muscle)/vertebral body was investigated. The area ratios were measured at the craniad L4 vertebral body end-plate level in axial CT images and regarded the ratio as the amount of each muscle. The area of fat and muscle in the major psoas and back muscles were investigated to clarify the quality of the trunk muscle. The area in which Hounsfield Unit was -100 to -50 and 30 to 120 were regarded as the area of fat and muscle in the major psoas and back muscles at L4 vertebral body end-plate level in axial CT images. The amount of PMMA used for BKP and difference of vertebral body height after BKP were also investigated.</p></div><div><h3>Results</h3><p>Significant difference was observed only in the area ratio of the back muscles/L4 vertebral body (average: 1.40 in Group A and 1.95 in Group B; p<.01). However, other factors, including the area ratio of the major psoas muscle /L4 vertebral body, have no significant difference between groups. In Group A, the area of fat in major psoas and back muscles were increased compared with Group B, and two patients who had AVF despite the higher area ratio of back muscles had low muscle quality. In Group B, 6 patients who had no additional AVF despite the lower area ratio of muscle had high muscle quality.</p></div><div><h3>CONCLUSION","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001069/pdfft?md5=e0532f01c742020a8c148bec9d477792&pid=1-s2.0-S2666548424001069-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839749","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}
<div><h3>Background Context</h3><p>Spinal cord stress and strain contributes to the pathophysiology of degenerative cervical myelopathy (DCM) and progressive cervical kyphosis can lead to worsening myelopathy. In DCM, the combination of spinal cord biomechanics, sagittal alignment and cord compression is known to increase spinal cord damage. However, the relationship between these biomechanical factors is not well understood. Quantifying spinal cord biomechanics and its relationship to sagittal alignment in DCM can guide surgical strategies that address adverse spinal cord stress and strain in addition to cord compression.</p></div><div><h3>Purpose</h3><p>To quantify the effect of cervical sagittal alignment on spinal cord stress and strain in the stenotic cervical spine.</p></div><div><h3>Study Design/Setting</h3><p>Finite element analysis.</p></div><div><h3>Patient Sample</h3><p>N/A.</p></div><div><h3>Outcome Measures</h3><p>Spinal cord stress and strain.</p></div><div><h3>Methods</h3><p>A previously validated three-dimensional finite element model of the human cervical spine with spinal cord was used. Three models of cervical alignment were created: lordosis (C2-C7 Cobb angle: 20 degrees), straight (0 degrees) and kyphosis (-9 degrees). Spinal cord prestress and prestrain due to spinal alignment was quantified. Progressive spinal stenosis was simulated at the C5-C6 segment with ventral disk protrusion that reduced the anteroposterior spinal canal diameter to 10mm, 8mm and 6mm. Flexion and extension of the cervical spine was simulated with a pure moment load of 2 Nm. The model was constrained at the inferior surface of the T1 vertebra in all degrees-of-freedom, and the sagittal moment loads were applied at the superior vertebra. An additional follower force of 75N to simulate the head mass and muscle force was applied. Von Mises stress and maximum principal strain of the whole cervical spinal cord was calculated during flexion and extension and added to the prestress and prestrain. The relationship between spinal cord biomechanics, alignment and cord compression was analyzed using linear regression analysis.</p></div><div><h3>Results</h3><p>Spinal cord prestress and prestrain was greatest for the kyphotic spine (7.53 kPa, 5.4%) and least for the lordotic spine (0.68 kPa, 0.3%). Progressive kyphosis and stenosis were associated with increase in spinal cord stress (R<sup>2</sup>=0.99) and strain (R<sup>2</sup>=0.99). For every 1 degree increase in kyphosis, average cervical spinal cord stress increased by 0.196 kPa and for every 1% increase in spinal cord compression, the von Mises stress increased by 1.86 kPa. Compared to straight and lordotic alignment, cervical kyphosis was associated with greater spinal cord stress and strain during neck flexion-extension and the magnitude of the difference was greater with increasing stenosis.</p></div><div><h3>Conclusions</h3><p>Cervical kyphosis increases spinal cord stress and strain and the effect is mag
{"title":"P4. Cervical kyphosis increases spinal cord stress and strain in the stenotic cervical spine during neck motion","authors":"Aditya Vedantam MD , Karthik Banurekha Devaraj BS , Balaji Harinathan MS , Narayan Yoganandan PhD","doi":"10.1016/j.xnsj.2024.100408","DOIUrl":"10.1016/j.xnsj.2024.100408","url":null,"abstract":"<div><h3>Background Context</h3><p>Spinal cord stress and strain contributes to the pathophysiology of degenerative cervical myelopathy (DCM) and progressive cervical kyphosis can lead to worsening myelopathy. In DCM, the combination of spinal cord biomechanics, sagittal alignment and cord compression is known to increase spinal cord damage. However, the relationship between these biomechanical factors is not well understood. Quantifying spinal cord biomechanics and its relationship to sagittal alignment in DCM can guide surgical strategies that address adverse spinal cord stress and strain in addition to cord compression.</p></div><div><h3>Purpose</h3><p>To quantify the effect of cervical sagittal alignment on spinal cord stress and strain in the stenotic cervical spine.</p></div><div><h3>Study Design/Setting</h3><p>Finite element analysis.</p></div><div><h3>Patient Sample</h3><p>N/A.</p></div><div><h3>Outcome Measures</h3><p>Spinal cord stress and strain.</p></div><div><h3>Methods</h3><p>A previously validated three-dimensional finite element model of the human cervical spine with spinal cord was used. Three models of cervical alignment were created: lordosis (C2-C7 Cobb angle: 20 degrees), straight (0 degrees) and kyphosis (-9 degrees). Spinal cord prestress and prestrain due to spinal alignment was quantified. Progressive spinal stenosis was simulated at the C5-C6 segment with ventral disk protrusion that reduced the anteroposterior spinal canal diameter to 10mm, 8mm and 6mm. Flexion and extension of the cervical spine was simulated with a pure moment load of 2 Nm. The model was constrained at the inferior surface of the T1 vertebra in all degrees-of-freedom, and the sagittal moment loads were applied at the superior vertebra. An additional follower force of 75N to simulate the head mass and muscle force was applied. Von Mises stress and maximum principal strain of the whole cervical spinal cord was calculated during flexion and extension and added to the prestress and prestrain. The relationship between spinal cord biomechanics, alignment and cord compression was analyzed using linear regression analysis.</p></div><div><h3>Results</h3><p>Spinal cord prestress and prestrain was greatest for the kyphotic spine (7.53 kPa, 5.4%) and least for the lordotic spine (0.68 kPa, 0.3%). Progressive kyphosis and stenosis were associated with increase in spinal cord stress (R<sup>2</sup>=0.99) and strain (R<sup>2</sup>=0.99). For every 1 degree increase in kyphosis, average cervical spinal cord stress increased by 0.196 kPa and for every 1% increase in spinal cord compression, the von Mises stress increased by 1.86 kPa. Compared to straight and lordotic alignment, cervical kyphosis was associated with greater spinal cord stress and strain during neck flexion-extension and the magnitude of the difference was greater with increasing stenosis.</p></div><div><h3>Conclusions</h3><p>Cervical kyphosis increases spinal cord stress and strain and the effect is mag","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266654842400101X/pdfft?md5=48aac21d804def9ca04ca788fcbabd1c&pid=1-s2.0-S266654842400101X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840110","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 : 2024-07-01DOI: 10.1016/j.xnsj.2024.100368
Go Goto MD , Tetsuro Oba MD, PhD , Hirotaka Haro MD, PhD
This abstract contains content that is significantly similar to the authors' previously published abstract in the Spine Surgery and Related Research. For access to the original publication, please visit the following DOI: https://doi.org/10.22603/ssrr.2023-0269.
{"title":"30. Clinical significance of pose estimation methods compared to radiographic parameters in adolescent idiopathic scoliosis patients.","authors":"Go Goto MD , Tetsuro Oba MD, PhD , Hirotaka Haro MD, PhD","doi":"10.1016/j.xnsj.2024.100368","DOIUrl":"10.1016/j.xnsj.2024.100368","url":null,"abstract":"<div><p>This abstract contains content that is significantly similar to the authors' previously published abstract in the <em>Spine Surgery and Related Research</em>. For access to the original publication, please visit the following DOI: <span><span>https://doi.org/10.22603/ssrr.2023-0269</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100368"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000611/pdfft?md5=f0af906da4e5676747215b4fd4ba6396&pid=1-s2.0-S2666548424000611-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844185","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 : 2024-07-01DOI: 10.1016/j.xnsj.2024.100349
JooYoung Lee MD , Dong-Ho Lee MD, PhD
<div><h3>BACKGROUND CONTEXT</h3><p>Anterior cervical discectomy and fusion (ACDF) provides clinical improvement for cervical radiculopathy, even without direct foraminal decompression, because it stabilizes the mobile segment and provides indirect decompression. Recently, it was determined that foraminal decompression via uncinate process resection could lead to faster and greater improvement of arm pain. Total uncinatectomy (TU) and partial uncoforaminotomy (PU) are commonly used for direct foraminal decompression.</p></div><div><h3>PURPOSE</h3><p>However, the advantages and pitfalls of the two techniques remain unknown. We aimed to compare the clinical outcomes and complications of TU and PU to determine the most suitable technique for foraminal decompression during ACDF.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Consecutive patients (n=306) who underwent single-level ACDF for degenerative cervical radiculopathy and who were followed up for >2 years were retrospectively reviewed. The patients were divided into two groups depending on the surgical technique: Group TU and Group PU. Subsidence, fusion, operative time, estimated blood loss (EBL), complications, and patient-reported outcome measures including arm pain visual analogue scale (VAS) score, neck pain VAS score, and neck disability index (NDI) were assessed and compared between the two groups.</p></div><div><h3>RESULTS</h3><p>Groups TU and PU included 152 (49.7%) and 154 (50.3%) patients, respectively. Group TU had a significantly higher degree of subsidence than Group PU. The 1-year (16 [10.5%] vs 6 [3.9%], p=0.025) and 2-year (11 [7.2%] vs 3 [1.9%], p=0.025) postoperative fusion rates were higher in Group PU than those in Group TU (16 [10.5%] vs 6 [3.9%], p=0.027). Postoperative arm pain VAS score, neck pain VAS score, and NDI scores did not demonstrate significant intergroup differences at all time points. Group TU had a significantly longer operative time (94.21±15.74 vs 81.04±16.92, p < .001), greater EBL (121.34±109.9 vs 71.83±85.71, p<.001), higher dysphasia rate (94 (61.8%) vs 75 (48.7%), p=0.021), and more severe retropharyngeal soft tissue swelling (18.20±5.02 vs 15.98±3.73, p=0.016) than Group PU did. There was one case (0.7%) of cerebral infarction due to vertebral artery injury in Group TU.</p></div><div><h3>CONCLUSIONS</h3><p>PU resulted in lesser complications, shorter operative time, and lesser intraoperative bleeding than did TU. While TU guarantees complete foraminal decompression during ACDF, it requires a longer time. Furthermore, excessive lateral exposure and retraction is needed to palpate the lateral margin of the uncinate for TU. This might cause greater postoperative neck swelling and dysphagia. Moreover, the uncinate process was partially preserved in PU as a potential stabilizer, causing lesser subsidence and higher fusion
背景 CONTEX前路颈椎椎间盘切除和融合术（ACDF）能改善颈椎病的临床症状，即使没有直接的椎管减压，因为它能稳定活动节段并提供间接减压。最近有研究发现，通过钩突切除术进行椎管减压可以更快、更大程度地改善手臂疼痛。全部钩突切除术（TU）和部分椎板切除术（PU）是直接进行椎管减压的常用方法。我们旨在比较 TU 和 PU 的临床疗效和并发症，以确定 ACDF 期间最适合的椎管减压技术。研究设计/设定N/受试者样本/疗效测量N/方法回顾性分析因退行性颈椎根病接受单水平 ACDF 的连续患者（n=306），并随访 >2年。根据手术技术将患者分为两组：TU组和PU组。对两组患者的下沉、融合、手术时间、估计失血量（EBL）、并发症以及患者报告的结果指标（包括手臂疼痛视觉模拟量表（VAS）评分、颈部疼痛视觉模拟量表（VAS）评分和颈部残疾指数（NDI））进行评估和比较。TU 组的下沉程度明显高于 PU 组。PU组术后1年（16 [10.5%] vs 6 [3.9%]，P=0.025）和2年（11 [7.2%] vs 3 [1.9%]，P=0.025）融合率均高于TU组（16 [10.5%] vs 6 [3.9%]，P=0.027）。术后手臂疼痛 VAS 评分、颈部疼痛 VAS 评分和 NDI 评分在所有时间点上均未显示出显著的组间差异。TU组的手术时间明显更长（94.21±15.74 vs 81.04±16.92，p <.001），EBL（121.34±109.9 vs 71.83±85.71，p <.001）更大，呼吸困难程度更高。001）、失语率更高（94（61.8%） vs 75（48.7%），p=0.021）、咽后软组织肿胀更严重（18.20±5.02 vs 15.98±3.73，p=0.016）。结论与 TU 相比，SPU 的并发症更少，手术时间更短，术中出血更少。虽然 TU 能保证 ACDF 中完全的椎管减压，但需要更长的时间。此外，TU 需要过多的外侧暴露和牵拉，才能触及椎弓根外侧缘。这可能会导致术后颈部肿胀和吞咽困难。此外，PU术中部分保留了作为潜在稳定器的钩突，导致较少的下陷和较高的融合率。不过，PU 的临床疗效与 TU 相当。因此，仅切除钩突后部可提供足够的直接椎孔减压。因此，在 ACDF 过程中，PU 可作为 TU 的有效且更安全的椎管减压替代物。FDA 器械/药物状态本摘要未讨论或包含任何适用的器械或药物。
{"title":"11. Foraminal decompression technique during ACDF for cervical radiculopathy that provides a better outcome: total uncinatectomy vs partial uncoforaminotomy","authors":"JooYoung Lee MD , Dong-Ho Lee MD, PhD","doi":"10.1016/j.xnsj.2024.100349","DOIUrl":"10.1016/j.xnsj.2024.100349","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Anterior cervical discectomy and fusion (ACDF) provides clinical improvement for cervical radiculopathy, even without direct foraminal decompression, because it stabilizes the mobile segment and provides indirect decompression. Recently, it was determined that foraminal decompression via uncinate process resection could lead to faster and greater improvement of arm pain. Total uncinatectomy (TU) and partial uncoforaminotomy (PU) are commonly used for direct foraminal decompression.</p></div><div><h3>PURPOSE</h3><p>However, the advantages and pitfalls of the two techniques remain unknown. We aimed to compare the clinical outcomes and complications of TU and PU to determine the most suitable technique for foraminal decompression during ACDF.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Consecutive patients (n=306) who underwent single-level ACDF for degenerative cervical radiculopathy and who were followed up for >2 years were retrospectively reviewed. The patients were divided into two groups depending on the surgical technique: Group TU and Group PU. Subsidence, fusion, operative time, estimated blood loss (EBL), complications, and patient-reported outcome measures including arm pain visual analogue scale (VAS) score, neck pain VAS score, and neck disability index (NDI) were assessed and compared between the two groups.</p></div><div><h3>RESULTS</h3><p>Groups TU and PU included 152 (49.7%) and 154 (50.3%) patients, respectively. Group TU had a significantly higher degree of subsidence than Group PU. The 1-year (16 [10.5%] vs 6 [3.9%], p=0.025) and 2-year (11 [7.2%] vs 3 [1.9%], p=0.025) postoperative fusion rates were higher in Group PU than those in Group TU (16 [10.5%] vs 6 [3.9%], p=0.027). Postoperative arm pain VAS score, neck pain VAS score, and NDI scores did not demonstrate significant intergroup differences at all time points. Group TU had a significantly longer operative time (94.21±15.74 vs 81.04±16.92, p < .001), greater EBL (121.34±109.9 vs 71.83±85.71, p<.001), higher dysphasia rate (94 (61.8%) vs 75 (48.7%), p=0.021), and more severe retropharyngeal soft tissue swelling (18.20±5.02 vs 15.98±3.73, p=0.016) than Group PU did. There was one case (0.7%) of cerebral infarction due to vertebral artery injury in Group TU.</p></div><div><h3>CONCLUSIONS</h3><p>PU resulted in lesser complications, shorter operative time, and lesser intraoperative bleeding than did TU. While TU guarantees complete foraminal decompression during ACDF, it requires a longer time. Furthermore, excessive lateral exposure and retraction is needed to palpate the lateral margin of the uncinate for TU. This might cause greater postoperative neck swelling and dysphagia. Moreover, the uncinate process was partially preserved in PU as a potential stabilizer, causing lesser subsidence and higher fusion ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000428/pdfft?md5=4b69d4cd04e6cccc95a9036f36b6da85&pid=1-s2.0-S2666548424000428-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848608","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}
<div><h3>Background Context</h3><p>The occurrence of postoperative bladder dysfunction is one of the most confusing complications for both patients and surgeons after lumbar spinal canal stenosis surgery.</p></div><div><h3>Purpose</h3><p>To investigate the risk factors for newly-onset postoperative bladder dysfunction.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>The study enrolled 738 cases among the patients who underwent lumbar spinal canal stenosis surgery between 2005 and 2020. Patients with severe preoperative bladder dysfunction (incontinence and urinary retention) or perioperative complications (intraoperative dural injury and long-term urinary catheter placement) were excluded. Patients who had urinary retention for at least 1 week after postoperative urinary catheter removal or who needed intermittent urinary drainage were included in the study.</p></div><div><h3>Outcome Measures</h3><p>The study items included patient background (age, sex, and duration), preoperative JOA score, and surgical factors (surgical procedures and number of decompressed segments). Propensity score-matching was performed at a ratio of 1:2 (postoperative bladder dysfunction group: subject group), and patient background (BMI, smoking history, comorbidities (hypertension, diabetes)), laboratory data (Cre, Chol, TG), imaging findings (lumbar spine alignment, dural canal area at each vertebra, type of cauda equina redundancy), and surgical factors (operation time, blood loss, and history of lumbar surgery) were investigated.</p></div><div><h3>Methods</h3><p>Univariate and multivariate analyses were performed to identify the risk factors for postoperative bladder dysfunction.</p></div><div><h3>Results</h3><p>Postoperative bladder dysfunction occurred in 23 (3.1 %) patients. At 1 year postoperatively, three patients required continued intermittent voiding, and four patients required continued medical treatment. Although the median recovery time in the improvement group was 41 days, only 12 patients (52.2%) showed improvement 3 months after surgery. Patients with postoperative bladder dysfunction were significantly older in all patient data. There were no significant differences in sex, duration, surgical procedures, or the number of decompressed segments. Univariate analysis performed after propensity score matching showed significant differences in imaging findings of curve type of cauda equina, ventral or dorsal deviation of the compressed dura mater, and the lumbar Cobb angle. There were no significant differences in laboratory data, history of lumbar surgery, or dural tube area at the most compressed segment. Multivariate analysis of all three factors was an independent factor.</p></div><div><h3>Conclusions</h3><p>Regardless of the preoperative patient background, surgical procedures, or number of decompressed segments, older patients and those with curve-type cauda equina were at a higher risk of devel
{"title":"P19. Risk factors for postoperative bladder dysfunction in lumbar spinal canal stenosis surgery","authors":"Hideaki Nakajima PhD, Shuji Watanabe PhD, Kazuya Honjoh PhD, Arisa Kubota MD, Akihiko Matsumine PhD","doi":"10.1016/j.xnsj.2024.100423","DOIUrl":"10.1016/j.xnsj.2024.100423","url":null,"abstract":"<div><h3>Background Context</h3><p>The occurrence of postoperative bladder dysfunction is one of the most confusing complications for both patients and surgeons after lumbar spinal canal stenosis surgery.</p></div><div><h3>Purpose</h3><p>To investigate the risk factors for newly-onset postoperative bladder dysfunction.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>The study enrolled 738 cases among the patients who underwent lumbar spinal canal stenosis surgery between 2005 and 2020. Patients with severe preoperative bladder dysfunction (incontinence and urinary retention) or perioperative complications (intraoperative dural injury and long-term urinary catheter placement) were excluded. Patients who had urinary retention for at least 1 week after postoperative urinary catheter removal or who needed intermittent urinary drainage were included in the study.</p></div><div><h3>Outcome Measures</h3><p>The study items included patient background (age, sex, and duration), preoperative JOA score, and surgical factors (surgical procedures and number of decompressed segments). Propensity score-matching was performed at a ratio of 1:2 (postoperative bladder dysfunction group: subject group), and patient background (BMI, smoking history, comorbidities (hypertension, diabetes)), laboratory data (Cre, Chol, TG), imaging findings (lumbar spine alignment, dural canal area at each vertebra, type of cauda equina redundancy), and surgical factors (operation time, blood loss, and history of lumbar surgery) were investigated.</p></div><div><h3>Methods</h3><p>Univariate and multivariate analyses were performed to identify the risk factors for postoperative bladder dysfunction.</p></div><div><h3>Results</h3><p>Postoperative bladder dysfunction occurred in 23 (3.1 %) patients. At 1 year postoperatively, three patients required continued intermittent voiding, and four patients required continued medical treatment. Although the median recovery time in the improvement group was 41 days, only 12 patients (52.2%) showed improvement 3 months after surgery. Patients with postoperative bladder dysfunction were significantly older in all patient data. There were no significant differences in sex, duration, surgical procedures, or the number of decompressed segments. Univariate analysis performed after propensity score matching showed significant differences in imaging findings of curve type of cauda equina, ventral or dorsal deviation of the compressed dura mater, and the lumbar Cobb angle. There were no significant differences in laboratory data, history of lumbar surgery, or dural tube area at the most compressed segment. Multivariate analysis of all three factors was an independent factor.</p></div><div><h3>Conclusions</h3><p>Regardless of the preoperative patient background, surgical procedures, or number of decompressed segments, older patients and those with curve-type cauda equina were at a higher risk of devel","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001161/pdfft?md5=fcf55c5d714e679ed1f8f4699ca26bd8&pid=1-s2.0-S2666548424001161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849833","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 : 2024-07-01DOI: 10.1016/j.xnsj.2024.100403
Sam H Jiang BS , Zayed A Almadidy MD , Morteza Sadeh MD, PhD , Dario Marotta DO , Ankit Indravadan Mehta MD
<div><h3>BACKGROUND CONTEXT</h3><p>Type II dens fractures are a traumatic injury of the second cervical vertebrae that often require surgical fusion to prevent spinal instability and further neurological insult. In elderly patients, clinicians often opt for conservative management over surgery due to an overall higher risk of complications in this population. For patients who do undergo surgery, frailty is often used to evaluate postoperative risk. The Modified Frailty Index 5 (mFI-5) is a concise metric that has been shown to have similar clinical utility as longer scales such as the Charlson Comorbidity Index and mFI-11.</p></div><div><h3>PURPOSE</h3><p>To evaluate and quantify which complications are more common following fusion for type II dens fractures for elderly patients with a high mFI-5 compared to those with a low mFI-5.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort database study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients from the American College of Surgeons National Trauma Data Bank (NTDB) from 2017-2021.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome measures are mortality and hospital length of stay (LOS). Secondary outcome measures entail hospital complications such as pressure ulcers and deep vein thrombosis and discharge disposition such as routine discharge to home and discharge to skilled nursing.</p></div><div><h3>METHODS</h3><p>The NTDB was queried from 2017-2021 for all patients with a traumatic type II dens fracture. Patients younger than 65 years, who did not undergo surgical fusion, or who were missing outcome data were excluded. The mFI-5 was calculated based on the presence of COPD, CHF, diabetes, hypertension, or functional impairment, with one point assigned to each. The categories were mFI-5 of 0, 1, or 2+. Propensity score matching was performed using the k-nearest neighbors algorithm based on patient age, sex, race, ethnicity, insurance type, and Glasgow Coma Scale. Patients with mFI-5 of 1 and 2+ were compared with patients with mFI-5 0 using Student's t-tests and Pearson's chi-square tests.</p></div><div><h3>RESULTS</h3><p>A total of 2278 patients matching the inclusion and exclusion criteria were identified, of which 457 had mFI-5 0, 907 had mFI-5 1, and 914 had mFI-5 2+. Following propensity score matching, 457 patients in each score group were identified. There were no significant post-match differences in outcomes between patients with mFI-5 0 and mFI-5 1. Compared to patients with mFI-5 0, patients with mFI-5 1 had a higher overall complication rate (77.46% vs 54.05%, p<0.01), lower rates of routine discharge to home (16.63% vs 23.41%, p=0.01) and higher rates of discharge to a skilled nursing facility (31.07% vs 23.63%, p=0.01). Patients with mFI-5 2+ similarly had higher complication rates (71.33% vs 54.05%, p<0.01), lower rates of routine discharge to home (9.63% vs 23.41%, p=0.01) and higher rates of discharge to a skilled nursing facility (37.63% vs 23.
背景 CONTEXTYPE II 型椎弓根骨折是第二颈椎的一种外伤性损伤，通常需要进行手术融合以防止脊柱不稳定和进一步的神经损伤。对于老年患者，临床医生通常会选择保守治疗，而不是手术治疗，因为老年患者出现并发症的风险较高。对于接受手术的患者，虚弱程度通常被用来评估术后风险。目的评估并量化高 mFI-5 老年患者与低 mFI-5 老年患者在 II 型椎体骨折融合术后哪些并发症更常见。研究设计/设置回顾性队列数据库研究。患者样本来自美国外科学院国家创伤数据库（NTDB）2017-2021年的患者。结果测量主要结果测量为死亡率和住院时间（LOS）。次要结局指标包括医院并发症（如压疮和深静脉血栓形成）和出院处置（如常规出院回家和出院到专业护理机构）。方法：在2017-2021年期间，对NTDB中所有外伤性II型穹隆骨折患者进行了查询。排除了年龄小于 65 岁、未进行手术融合或结果数据缺失的患者。mFI-5 根据是否患有慢性阻塞性肺病、慢性心力衰竭、糖尿病、高血压或功能障碍进行计算，每种情况得一分。mFI-5分为0、1或2+。根据患者的年龄、性别、种族、民族、保险类型和格拉斯哥昏迷量表，使用 k 近邻算法进行倾向得分匹配。采用学生 t 检验和皮尔逊卡方检验将 mFI-5 为 1 和 2+ 的患者与 mFI-5 为 0 的患者进行比较。结果共确定了 2278 名符合纳入和排除标准的患者，其中 457 名 mFI-5 为 0，907 名 mFI-5 为 1，914 名 mFI-5 为 2+。经过倾向评分匹配后，每个评分组均确定了 457 名患者。与 mFI-5 0 患者相比，mFI-5 1 患者的总体并发症发生率更高（77.46% vs 54.05%，p<0.01），常规出院回家的比例更低（16.63% vs 23.41%，p=0.01），出院到专业护理机构的比例更高（31.07% vs 23.63%，p=0.01）。mFI-5 2+ 患者的并发症发生率同样较高（71.33% vs 54.05%，p<0.01），常规出院回家的比例较低（9.63% vs 23.41%，p=0.01），出院到专业护理机构的比例较高（37.63% vs 23.63%，p=0.01），此外，患者的生命周期较长（12.19 vs 10.18 天，p<0.01）。结论 在接受手术融合的外伤性 II 型椎弓根骨折老年患者中，中度和高度虚弱（分别以 mFI-5 为 1 和 2+ 为指标）与术后并发症的发生率增加约 20%，以及更多患者出院前往专业护理机构有关。颈椎融合术仍是体弱程度较低的老年患者治疗II型椎体骨折的标准方法，但对于体弱程度较高的老年患者，必须更加注意个体化治疗。
{"title":"65. Cervical fusion in frail elderly patients with type II dens fractures: a propensity score matched analysis based on the 5-item modified frailty index","authors":"Sam H Jiang BS , Zayed A Almadidy MD , Morteza Sadeh MD, PhD , Dario Marotta DO , Ankit Indravadan Mehta MD","doi":"10.1016/j.xnsj.2024.100403","DOIUrl":"10.1016/j.xnsj.2024.100403","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Type II dens fractures are a traumatic injury of the second cervical vertebrae that often require surgical fusion to prevent spinal instability and further neurological insult. In elderly patients, clinicians often opt for conservative management over surgery due to an overall higher risk of complications in this population. For patients who do undergo surgery, frailty is often used to evaluate postoperative risk. The Modified Frailty Index 5 (mFI-5) is a concise metric that has been shown to have similar clinical utility as longer scales such as the Charlson Comorbidity Index and mFI-11.</p></div><div><h3>PURPOSE</h3><p>To evaluate and quantify which complications are more common following fusion for type II dens fractures for elderly patients with a high mFI-5 compared to those with a low mFI-5.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort database study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients from the American College of Surgeons National Trauma Data Bank (NTDB) from 2017-2021.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome measures are mortality and hospital length of stay (LOS). Secondary outcome measures entail hospital complications such as pressure ulcers and deep vein thrombosis and discharge disposition such as routine discharge to home and discharge to skilled nursing.</p></div><div><h3>METHODS</h3><p>The NTDB was queried from 2017-2021 for all patients with a traumatic type II dens fracture. Patients younger than 65 years, who did not undergo surgical fusion, or who were missing outcome data were excluded. The mFI-5 was calculated based on the presence of COPD, CHF, diabetes, hypertension, or functional impairment, with one point assigned to each. The categories were mFI-5 of 0, 1, or 2+. Propensity score matching was performed using the k-nearest neighbors algorithm based on patient age, sex, race, ethnicity, insurance type, and Glasgow Coma Scale. Patients with mFI-5 of 1 and 2+ were compared with patients with mFI-5 0 using Student's t-tests and Pearson's chi-square tests.</p></div><div><h3>RESULTS</h3><p>A total of 2278 patients matching the inclusion and exclusion criteria were identified, of which 457 had mFI-5 0, 907 had mFI-5 1, and 914 had mFI-5 2+. Following propensity score matching, 457 patients in each score group were identified. There were no significant post-match differences in outcomes between patients with mFI-5 0 and mFI-5 1. Compared to patients with mFI-5 0, patients with mFI-5 1 had a higher overall complication rate (77.46% vs 54.05%, p<0.01), lower rates of routine discharge to home (16.63% vs 23.41%, p=0.01) and higher rates of discharge to a skilled nursing facility (31.07% vs 23.63%, p=0.01). Patients with mFI-5 2+ similarly had higher complication rates (71.33% vs 54.05%, p<0.01), lower rates of routine discharge to home (9.63% vs 23.41%, p=0.01) and higher rates of discharge to a skilled nursing facility (37.63% vs 23.","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100403"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000969/pdfft?md5=286d58ae2f11035d154d168d1b678753&pid=1-s2.0-S2666548424000969-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850174","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}
<div><h3>BACKGROUND CONTEXT</h3><p>Tranexamic acid (TXA), a synthetic antifibrinolytic drug, competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, thus reducing bleeding. Intravenous TXA has been used to effectively reduce perioperative blood loss in spinal surgery. However, high-dose intravenous TXA may cause complications, such as seizures, deep vein thrombosis (DVT), and pulmonary embolism (PE). In contrast, topical TXA has been used to avoid the risk of such complications and has shown efficacy in reducing total blood loss in spine surgery. Topical TXA has a similar hemostatic efficacy to intravenous TXA. However, whether intravenous or topical TXA is more effective in reducing postoperative bleeding in spine surgery remains unclear.</p></div><div><h3>PURPOSE</h3><p>This study aimed to compare the efficacy and safety of topical and relatively high-dose intravenous tranexamic acid (TXA) in reducing postoperative blood loss in patients undergoing single-level posterior lumbar interbody fusion (PLIF). The same timing of administration was used for both formulations.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study was a nonrandomized case-control study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 120 patients diagnosed with single-level degenerative lumbar disease underwent single-level PLIF at our hospital between 2016 and 2023.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome was postoperative blood loss, which was evaluated by measuring the output from the suction drain. Secondary outcomes included estimated total perioperative blood loss, hemoglobin (Hb) level, hemoglobin variations (Hbv), and incidence of allogeneic blood transfusion. The total perioperative blood loss was calculated using Hbv. Hbv (g/dL) were calculated from before surgery to POD4 and POD7, and the lower of the two values was included in the analyses.</p></div><div><h3>METHODS</h3><p>A total of 120 patients were retrospectively enrolled and assigned to three groups: (a) control group, which received no TXA; (b) TXA (iv) group, which received intravenous administration of a relatively high dose (2 g) of TXA immediately before wound closure; and (c) TXA (t) group, which received topical application of TXA (1 g in 100 mL saline solution) to the wound immediately before wound closure. The drain was released 20 minutes after topical or intravenous TXA administration.</p></div><div><h3>RESULTS</h3><p>A total of 120 patients were included in the study: control group, n = 60; TXA (iv) group, n = 30; and TXA (t) group, n = 30. Total postoperative blood loss was significantly lower in the TXA (t) group than in the TXA (iv) and control groups (350.8±132.6 vs 566.4±178.8 vs 704.4±225.9, respectively; both p<0.01, unit: ml). Analysis of blood loss over time showed significantly less blood loss throughout the postoperative period in the TXA (t) group compared with the control group; in contrast, the TXA (i
{"title":"64. Comparison of the effects of topical and intravenous administration of tranexamic acid on postoperative blood loss in single-level posterior lumbar interbody fusion","authors":"Kazuma Kitaguchi MD, PhD , Takashi Kaito MD, PhD , Eiji Wada MD","doi":"10.1016/j.xnsj.2024.100402","DOIUrl":"10.1016/j.xnsj.2024.100402","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Tranexamic acid (TXA), a synthetic antifibrinolytic drug, competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, thus reducing bleeding. Intravenous TXA has been used to effectively reduce perioperative blood loss in spinal surgery. However, high-dose intravenous TXA may cause complications, such as seizures, deep vein thrombosis (DVT), and pulmonary embolism (PE). In contrast, topical TXA has been used to avoid the risk of such complications and has shown efficacy in reducing total blood loss in spine surgery. Topical TXA has a similar hemostatic efficacy to intravenous TXA. However, whether intravenous or topical TXA is more effective in reducing postoperative bleeding in spine surgery remains unclear.</p></div><div><h3>PURPOSE</h3><p>This study aimed to compare the efficacy and safety of topical and relatively high-dose intravenous tranexamic acid (TXA) in reducing postoperative blood loss in patients undergoing single-level posterior lumbar interbody fusion (PLIF). The same timing of administration was used for both formulations.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study was a nonrandomized case-control study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 120 patients diagnosed with single-level degenerative lumbar disease underwent single-level PLIF at our hospital between 2016 and 2023.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome was postoperative blood loss, which was evaluated by measuring the output from the suction drain. Secondary outcomes included estimated total perioperative blood loss, hemoglobin (Hb) level, hemoglobin variations (Hbv), and incidence of allogeneic blood transfusion. The total perioperative blood loss was calculated using Hbv. Hbv (g/dL) were calculated from before surgery to POD4 and POD7, and the lower of the two values was included in the analyses.</p></div><div><h3>METHODS</h3><p>A total of 120 patients were retrospectively enrolled and assigned to three groups: (a) control group, which received no TXA; (b) TXA (iv) group, which received intravenous administration of a relatively high dose (2 g) of TXA immediately before wound closure; and (c) TXA (t) group, which received topical application of TXA (1 g in 100 mL saline solution) to the wound immediately before wound closure. The drain was released 20 minutes after topical or intravenous TXA administration.</p></div><div><h3>RESULTS</h3><p>A total of 120 patients were included in the study: control group, n = 60; TXA (iv) group, n = 30; and TXA (t) group, n = 30. Total postoperative blood loss was significantly lower in the TXA (t) group than in the TXA (iv) and control groups (350.8±132.6 vs 566.4±178.8 vs 704.4±225.9, respectively; both p<0.01, unit: ml). Analysis of blood loss over time showed significantly less blood loss throughout the postoperative period in the TXA (t) group compared with the control group; in contrast, the TXA (i","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100402"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000957/pdfft?md5=2386191fb9cf89710b0f558d77deee6f&pid=1-s2.0-S2666548424000957-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852698","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号