World Neurosurgery: X最新文献_第3页

Craniospinal space reduction and malalignment due to atlas assimilation in Basilar Invagination–A case–control study 基底动脉内陷症患者颅椎间隙缩小和寰椎同化引起的对位不正--病例对照研究

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-26 DOI: 10.1016/j.wnsx.2024.100418

Ricardo V. Botelho , Beatriz Cibin Braga Petranchi , Pedro B. Botelho , Diego U.M. Moreira , Eduardo F. Bertolini , José M. Rotta

Introduction

Type I Basilar invagination is associated with the assimilation of the anterior arch of the atlas. Observation suggests that the assimilation of the atlas does not allow the development of the normal space between the skull and C1 and displaces the high cervical spine towards the neural structures, posteriorly positioned. Purpose: The objective of this work is to evaluate craniospinal alignment in patients with type I Basilar invagination and AOA in comparison with normal subjects (Type I).

Methods

Magnetic resonance images and / or CT SCAN with reconstruction in the midline, in acquisitions at t1 and or t2, from 30 normal subjects and 27 patients with type I Basilar invagination were evaluated. The position of Anterior arch of Atlas and odontoid process in relation to the Basion and distances between C1 and C2 to the anterior border of foramen magnum were compared between groups.

Results

The distance from C2 to the Basion was significantly higher in the BI group than in the control group (t test: t = 4.18; p = 0) and the space between the skull and Atlas was reduced. All normal subjects had the Atlas anteriorly located in relation to the Basion. In AOA, all patients had Atlas in line with or posteriorly dislocated in relation to the Basion and the Odontoid process occupying the foramen magnum space.

Conclusion

data revealed that AOA prevents a normal position of skull in relation to the Atlas and a presumed “slip-back” cranio-spinal displacement during developmental period.

导言Ⅰ型基底内陷与寰椎前弓同化有关。观察结果表明，寰椎的同化导致颅骨和 C1 之间的空间无法正常发育，并使高位颈椎向后方的神经结构移位。方法对 30 名正常人和 27 名 I 型基底动脉内陷患者的磁共振图像和/或 CT SCAN 进行评估，在 t1 和/或 t2 采集时进行中线重建。结果BI 组 C2 到 Basion 的距离明显高于对照组（t 检验：t = 4.18；p = 0），头骨和 Atlas 之间的空间缩小。所有正常人的 Atlas 相对于 Basion 都位于前方。结论数据显示，AOA阻碍了头骨与Atlas的正常位置，并推测在发育期间颅脊柱发生了 "后滑 "移位。

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引用次数: 0

Evaluation of the Chetomin effect on histopathological features in a murine acute spinal cord injury model 评估 Chetomin 对小鼠急性脊髓损伤模型组织病理学特征的影响

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-26 DOI: 10.1016/j.wnsx.2024.100414

Carlos César Bravo-Reyna , Vladimir Miranda-Galván , Gervith Reyes-Soto , R. Vicuña , Jorge Alanis-Mendizabal , Manuel Escobar-Valderrama , David Arango , Claudia J. Bautista , Victoria Ramírez , Gonzalo Torres-Villalobos

Background

Several research studies have been focused on improving the treatment and prognosis of acute spinal cord injury, as part of this initiative we investigated the use of Chetomin to reduce the inflammatory response in this pathology.

Methods

An experimental, prospective, cross-sectional study was performed using 42 Wistar rats where we analyzed the effect of Chetomin compared to methylprednisolone administered 1 and 8 h after the spinal cord injury in a murine model.

Results

Chetomin administration 8h post-injury decreased IL-6 and VEGF expression; and, and its administration 1h post-injury decreased NF-kB expression.

Conclusions

Chetomin has anti-inflammatory effects in acute spinal cord injury, whether these effects are observable with other proinflammatory markers should be investigated.

方法我们使用 42 只 Wistar 大鼠进行了一项实验性、前瞻性、横断面研究，在小鼠模型中分析了脊髓损伤后 1 小时和 8 小时服用 Chetomin 与甲基强的松龙相比的效果。结论 Chetomin 对急性脊髓损伤有抗炎作用，但这些作用是否可通过其他促炎标记物观察到，还有待进一步研究。

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引用次数: 0

Early clinical outcomes and medical complications following long segment fusion for adult spinal deformity with and without three column osteotomy 采用或不采用三柱截骨术进行成人脊柱畸形长节段融合术后的早期临床疗效和医疗并发症

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-25 DOI: 10.1016/j.wnsx.2024.100415

Simon G. Ammanuel, Paul S. Page, Garret P. Greeneway, Darius Ansari, James A. Stadler

Background

Surgical treatment of adult spinal deformity (ASD) commonly involves long-segment fusion with or without three column osteotomies (3CO) to provide satisfactory correction of sagittal and coronal balance. While some clinical studies have implicated 3CO as a driver of high surgical complication rates, these prior investigations are limited by small sample size. Herein, we compare early outcomes and adverse events in patients undergoing long segment posterior spinal fusion for ASD with and without 3CO.

Methods

A multicenter administrative database was queried for patients undergoing elective posterior spinal fusion for ASD. Patients were stratified based upon long segment fusion with and without 3CO. Preoperative patient demographics, procedural characteristics, hospitalization events, and postoperative complication rates were evaluated. Student's t-test and Fisher's exact test were utilized where appropriate to compare differences between the two groups for continuous and categorical variables.

Results

340 cases met the inclusion criteria, of which 156 involved 3CO. Patients who required 3CO had a lower rate of preoperative diabetes (22.3 % vs 10.3 %, p = 0.003), higher rates of non-home discharge (26.2 % vs 57.1 %, p < 0.001), longer operation time (245.62 ± 9.45 vs. 434.40 ± 11.65, p < 0.001), and longer length of stay (4.17 ± 0.66 vs. 7.76 ± 0.83, p < 0.001). In terms of complications, 3CO patients had higher rates of deep surgical site infection (0 % vs 3.2 %, p = 0.02), reintubation (0 % vs 4.5 %, p = 0.004), inability to wean off ventilator (0 % vs 2.6 %, p = 0.04), and perioperative blood transfusion (20.1 % vs 76.3 %, p < 0.001).

Conclusions

In this retrospective analysis, posterior 3CO was frequently undertaken but associated with higher risk for postoperative adverse events following spinal deformity correction.

背景成人脊柱畸形（ASD）的手术治疗通常包括长节段融合，同时进行或不进行三柱截骨（3CO），以达到令人满意的矢状和冠状平衡矫正效果。虽然一些临床研究认为三柱截骨术是导致手术并发症发生率高的原因之一，但由于样本量较小，这些先前的研究受到了限制。在此，我们比较了因 ASD 而接受长节段脊柱后路融合术的患者有无 3CO 的早期结果和不良事件。根据有无 3CO 的长节段融合术对患者进行了分层。对术前患者的人口统计学特征、手术特征、住院事件和术后并发症发生率进行了评估。采用学生 t 检验和费雪精确检验来比较两组间连续变量和分类变量的差异。需要 3CO 的患者术前患糖尿病的比例较低（22.3 % vs 10.3 %，p = 0.003），非居家出院的比例较高（26.2 % vs 57.1 %，p < 0.001），手术时间较长（245.62 ± 9.45 vs 434.40 ± 11.65，p < 0.001），住院时间较长（4.17 ± 0.66 vs 7.76 ± 0.83，p < 0.001）。在并发症方面，3CO 患者的手术部位深部感染率（0 % vs 3.2 %，p = 0.02）、再次插管率（0 % vs 4.5 %，p = 0.004）、无法脱离呼吸机率（0 % vs 2.6 %，p = 0.04）和围手术期输血率（20.结论在这项回顾性分析中，脊柱畸形矫正术后经常使用后路 3CO，但术后发生不良事件的风险较高。

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引用次数: 0

Minimally invasive exoscope-assisted coccygectomy: A novel approach for chronic refractory coccydynia 微创外镜辅助尾骨切除术：治疗慢性难治性尾骨痛的新方法

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-25 DOI: 10.1016/j.wnsx.2024.100412

Barnabas Obeng-Gyasi, Danielle Wilmes, Matthew P. Blackwell, Jae H. Kwon, Gordon Mao

Background

This technical note presents a novel minimally invasive exoscope assisted coccygectomy to treat chronic refractory coccydynia. Traditional treatments often fail to provide adequate relief for this debilitating condition, prompting the need to explore surgical approaches.

Case Description

A 40-year-old female patient with persistent pain unresponsive to conservative treatments underwent this advanced procedure. Utilizing the Synaptive exoscope-microscope system, the surgery allowed for precise dissection and removal of affected coccygeal segments, with a focus on minimizing skin and soft tissue disruption to optimize wound healing and surgical site pain.

Conclusion

Postoperative recovery showcased significant pain reduction and improved quality of life, emphasizing the method's potential for better outcomes and fewer complications. Despite the promising results, the limitations of a single-case study necessitate further research to establish long-term effectiveness across a broader patient population.

背景本技术说明介绍了一种新型微创外镜辅助尾骨切除术，用于治疗慢性难治性尾骨痛。传统治疗方法往往无法充分缓解这种使人衰弱的病症，因此需要探索手术方法。病例描述一位 40 岁的女性患者因对保守治疗无效的持续性疼痛接受了这种先进的手术。利用 Synaptive 外窥镜显微系统，手术可以精确解剖和切除受影响的尾骨节段，重点是尽量减少对皮肤和软组织的破坏，以优化伤口愈合和手术部位的疼痛。尽管结果令人鼓舞，但由于单例研究的局限性，有必要在更广泛的患者群体中开展进一步研究，以确定其长期有效性。

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引用次数: 0

Placement of spinal cord stimulation paddle leads in the thoracic spine using en bloc laminoplasty: A technical note 使用整体板层成形术在胸椎放置脊髓刺激桨导线：技术说明

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-23 DOI: 10.1016/j.wnsx.2024.100400

Samuel D. Stegelmann , Roman Rahmani , Jae Min Yim , Zubair Ahammad

Objective

Spinal cord stimulation (SCS) has become a successful treatment option for managing chronic pain syndromes. Conventional methods for placing SCS leads include percutaneous insertion or open laminectomy in cases requiring better visualization. However, achieving accurate placement of paddle leads while minimizing surgical invasiveness remains a challenge in cases with anatomic constraints such as dural scarring.

Methods

We present a novel surgical technique for the placement of SCS paddle leads in the thoracic spine using en bloc laminoplasty, which is currently employed at our institution for patients with chronic pain syndromes.

Conclusions

This technique can provide accurate placement of paddle leads in patients with anatomic constraints or dural scarring that impede percutaneous implantation. Additionally, it offers potential structural advantages over laminectomy by reconstituting posterior stabilization and protection of the paddle leads.

目的脊髓刺激（SCS）已成为治疗慢性疼痛综合征的一种成功疗法。放置 SCS 导联的传统方法包括经皮插入或在需要更好可视化的病例中进行开放性椎板切除术。然而，在硬脊膜瘢痕等解剖限制的病例中，如何实现桨状导联的精确置入，同时最大限度地减少手术创口，仍然是一项挑战。方法我们介绍了一种新的手术技术，利用整体椎板成形术在胸椎中置入 SCS 桨状导联，该技术目前在我院用于慢性疼痛综合征患者的治疗。此外，与椎板切除术相比，该技术还具有潜在的结构优势，可重建桨状导联的后方稳定和保护。

引用次数: 0

Assessment of donor-vessel after STA-MCA bypass for moyamoya disease using handheld Doppler to confirm bypass patency and predict perioperative hyperperfusion 使用手持式多普勒对用于治疗 moyamoya 病的 STA-MCA 旁路术后的供体血管进行评估，以确认旁路的通畅性并预测围手术期的高灌注情况

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-23 DOI: 10.1016/j.wnsx.2024.100398

Satoshi Takahashi, Masahiro Toda

The study included 12 hemispheres of 9 patients with moyamoya disease who underwent direct-indirect revascularization. The parameters (peak systolic velocity (PSV), mean flow velocity (MV), resistance index (RI), flow volume (FV)) of the superficial temporal artery (STA) on the operated side were measured using a handheld Doppler before and after surgery in all the patients. The examination was conducted in a similar manner on postoperative day (POD)1 on 9 sides of 7 patients except for 3 sides of the first 2 patients. Patency of the superficial temporal artery-middle cerebral artery (STA-MCA) bypass was confirmed by magnetic resonance angiography (MRA) performed on all 12 sides of 9 patients within the first 2 PODs. There was a statistically significant increase in the PSV (p = 0.0201) and the MV (p = 0.0110) and a decrease in the RI (p = 0.0177) in the STA after surgery when compared with those measured before surgery. None of the changes from the immediate postoperative period to POD1 were statistically significant. Postoperative transient neurological events (TNEs) occurred in 3 patients (25 %) in the first 2 weeks, and all of them were attributed to hyperperfusion. The FV of the three sides associated with TNEs was significantly higher than that of the nine sides that were not (p = 0.0273). From the early stage after moyamoya disease bypass surgery, it was clarified that the parameter of the STA changed in which the PSV and the MV increased and the RI decreased. It was clarified that the increase in the FV, which is the blood flow rate that flows through the STA in the immediate postoperative period, may be a predictor of the development of hyperperfusion during the perioperative course.

该研究包括9名接受直接-间接血管重建术的moyamoya病患者的12个半球。所有患者在手术前后均使用手持式多普勒测量了手术侧颞浅动脉（STA）的参数（收缩峰值速度（PSV）、平均流速（MV）、阻力指数（RI）、血流量（FV））。在术后第 1 天（POD）以类似的方式对 7 名患者的 9 侧进行了检查，但前 2 名患者的 3 侧除外。在术后第 2 天，对 9 名患者的所有 12 侧进行了磁共振血管造影（MRA）检查，以确认颞浅动脉-大脑中动脉（STA-MCA）旁路的通畅性。与手术前的测量结果相比，手术后 STA 的 PSV（p = 0.0201）和 MV（p = 0.0110）明显增加，RI（p = 0.0177）明显减少。从术后即刻到 POD1 的变化均无统计学意义。术后头两周内有 3 名患者（25%）发生了一过性神经事件（TNEs），所有这些事件都归因于高灌注。与 TNEs 相关的 3 个侧的 FV 明显高于未发生 TNEs 的 9 个侧（P = 0.0273）。从莫亚莫亚病搭桥手术后的早期阶段开始，STA 的参数发生了变化，其中 PSV 和 MV 增加，RI 减少。这说明，FV（即术后初期流经 STA 的血流量）的增加可能是围手术期发生高灌注的预测因素。

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引用次数: 0

Diabetes and heart disease do not affect short-term lumbar fusion outcomes accounting for other risk factors in a matched cohort analysis 在一项匹配队列分析中，考虑到其他风险因素，糖尿病和心脏病不会影响短期腰椎融合术的效果

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-23 DOI: 10.1016/j.wnsx.2024.100410

Ryan S. Gallagher , Connor A. Wathen , Ritesh Karsalia , Austin J. Borja , Tara Collier , Jianbo Na , Scott McClintock , Paul J. Marcotte , James M. Schuster , William C. Welch , Neil R. Malhotra

Objectives

Comprehensive preoperative management involves the identification and optimization of medical comorbidities while avoiding excessive healthcare utilization. While diabetes and heart disease are major causes of morbidity that can worsen surgical outcomes, further study is needed to evaluate how well current perioperative strategies mitigate their risks. This study employs an exact matching protocol to isolate the effects of both diabetes and cardiovascular disease on spine surgery outcomes.

Methods

4680 consecutive patients undergoing single-level, posterior-only lumbar fusion were retrospectively enrolled. Univariate logistic regression was performed on comorbidity subgroups, then coarsened exact matching (CEM) was employed for patients with diabetes or cardiovascular disease. Patients were matched 1:1 on ten patient and procedural characteristics known to affect neurosurgical outcomes. Separate pairs of exact-matched cohorts were generated to isolate both cardiovascular disease (matched n = 192), and diabetes (matched n = 380). Primary outcomes were surgical complications; length of stay; discharge disposition (home vs. non-home); and 30- and 90-day Emergency Department (ED) visits, readmissions, reoperations, and mortality.

Results

Cardiovascular disease and diabetes subgroups were not associated with short term outcomes after matching to control for confounders. Compared to univariate statistics, this method demonstrates that confounding control variables may drive outcomes more than these comorbidities themselves.

Conclusion

Between otherwise exactly matched patients undergoing lumbar fusion, diabetes and cardiovascular disease posed no greater risk of short-term adverse outcomes. This suggests proper selection criteria for surgical candidates and effective current perioperative strategies to mitigate these common comorbidities. Further studies are warranted to assess and optimize the cost-effectiveness of preoperative management for patients with common comorbidities.

目的全面的术前管理包括识别和优化合并症，同时避免过度使用医疗服务。糖尿病和心脏病是导致手术效果恶化的主要发病原因，因此需要进一步研究来评估目前的围手术期策略能在多大程度上降低这两种疾病的风险。本研究采用精确配对方案来分离糖尿病和心血管疾病对脊柱手术结果的影响。方法回顾性地纳入了4680例连续接受单层后路腰椎融合术的患者。对合并症亚组进行了单变量逻辑回归，然后对糖尿病或心血管疾病患者进行了精确匹配（CEM）。对已知会影响神经外科手术结果的十种患者和手术特征进行了 1:1 匹配。精确匹配队列中的两对患者分别患有心血管疾病（匹配 n = 192）和糖尿病（匹配 n = 380）。主要结果包括手术并发症、住院时间、出院处置（居家与非居家）、30 天和 90 天急诊室就诊、再入院、再次手术和死亡率。结论在接受腰椎融合术的完全匹配的患者中，糖尿病和心血管疾病不会带来更大的短期不良后果风险。这表明手术候选者的选择标准是正确的，目前的围手术期策略也能有效缓解这些常见合并症。有必要开展进一步的研究，以评估和优化常见合并症患者术前管理的成本效益。

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引用次数: 0

Ambient wing cistern: History, anatomy, imaging and approaches: An overview 环境翼贮水池：历史、解剖、成像和方法：概述

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-21 DOI: 10.1016/j.wnsx.2024.100395

Mohamed R. Emara , Alkawthar M. Abdulsada , Abdulaziz S. Alayyaf , Hussein A. Baban , Hala A. Al-Hchaimi , Mustafa Ismail , Samer S. Hoz

Background

The ambient cistern is a noncommunicating paramedian dorsal paired cistern according to the Liliequist classification. While the ambient wing cistern is described for the first time in 1875, Key and Retzius and firstly named in 1950 by Dr. Bengt Liliequist (1923–2008). Due to its complex tridimensional anatomy, it has been a subject of confusion in neuroanatomy. Historically, it has been given multiple anatomical definitions. Our paper focuses on the history, development, radiology, and lesions of the AC along with the AWC and explains the latter as an independently constant anatomical structure.

Method

Pubmed and Google Scholar were both consulted for the advanced literature research using the following search string on Pubmed: ((("ambient") AND ("wing")) OR (((retrothalamic) OR (retropulvinar)) (intercommunicant))) AND ("cister∗")) NOT("temprature"). In addition to the following string on Google scholar: Ambient AND wing cisterna OR cistern.

Results

836 results were obtained, after exclusion of unrelated engineering articles and veterinary papers, only 60 papers remained. Ambient wing, retrothalamic, retropulvinar & intercommunicant cisterns were mentioned within the related 60 articles but none of them explained it as a whole research entity independently.

Conclusion

The ambient cistern has supratentorial and infratentorial parts and is continuous with basal cisterns posteriorly giving rise to the ambient wing cistern. They are believed to be separate constantly existing anatomical structures despite their intimate communication and axial perpendicularity. The wing of AC has significance importance in the diagnosis and treatment of the masses lying adjacent to the tentorial hiatus. It can be exposed either by sub temporal or occipital interhemispheric approach as it locates inferoposteriorly to the AC.

背景根据 Liliequist 的分类，常温翼贮水池是一种不交流的副背侧成对贮水池。1875 年，Key 和 Retzius 首次描述了常温翼状蝶窦，1950 年，Bengt Liliequist 博士（1923-2008 年）首次命名了常温翼状蝶窦。由于其复杂的三维解剖结构，它在神经解剖学中一直是一个令人困惑的问题。在历史上，它曾被赋予多种解剖学定义。我们的论文将重点放在 AC 与 AWC 的历史、发展、放射学和病变上，并将后者解释为一个独立恒定的解剖结构。方法在 Pubmed 和 Google Scholar 上使用以下搜索字符串进行高级文献研究：（（（"环境"） AND （"翼"）)或 (((retropulvinar)) (intercommunicant)))AND ("cister∗")) NOT("temprature").此外，谷歌学术上还有以下字符串：Ambient（环境） AND wing cisterna OR cistern.Results（结果）836 条结果，在排除了无关的工程学文章和兽医学论文后，只剩下 60 篇论文。在相关的 60 篇文章中提到了常温翼贮水池、后丘脑贮水池、后丘脑贮水池和amp; intercommunicant贮水池，但没有一篇文章将其作为一个独立的整体研究实体进行解释。尽管它们之间有密切联系且轴向垂直，但人们认为它们是独立的、持续存在的解剖结构。在诊断和治疗位于触骨裂孔附近的肿块时，交流翼具有重要意义。它可以通过颞下或枕部半球间入路暴露，因为它位于 AC 的后下方。

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引用次数: 0

Intracranial pressure changes in traumatic brain injury patients undergoing unilateral decompressive craniectomy with dural expansion 接受单侧硬脑膜扩张减压开颅术的脑外伤患者的颅内压变化

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-21 DOI: 10.1016/j.wnsx.2024.100405

Idris Shahrom , Saiful Azli Mat Nayan , Jafri Malin Abdullah , Abdul Rahman Izaini Ghani , Nurul Firdausi Hasnol Basri , Zamzuri Idris

Background

The aim of this study is to assess the ICP changes induced by a unilateral fronto-temporo-parietal DC with dural expansion after moderate to severe TBI. The effect of different bone flap sizes on ICP and the neurological outcomes were also evaluated after the decompressive surgery.

Methods

52 TBI patients with clinical and radiological evidences of increased ICP were included in this prospective study. All patients received unilateral fronto-temporo-parietal DC with dural expansion and ventriculostomy at contralateral Kocher's point. Postoperatively, ICP values and the largest antero-posterior (AP) diameter of bone flap removed was measured, and the clinical outcomes were assessed using Extended Glasgow Outcome Scale (GOS-E) at discharge and 6 months after DC.

Results

The median ICP significantly decreased with an average of 56.7 % reduction from the initial opening ICP. Similar ICP changes were observed in all groups. This study also found that the large bone flap group (AP diameter >15 cm) demonstrated better postoperative ICP control as compared to the small bone flap group (AP diameter 12–15 cm), although not statistically significant. The SDH and cerebral swelling groups did better in the GOS-E at 6 months after TBI compared with cerebral contusion group.

Conclusion

The ICP reduction in moderate to severe TBI patients undergoing unilateral fronto-temporo-parietal DC with dural expansion occurred in accordance with decompressive steps, regardless of intracranial lesions and the surgical procedure should be performed with the bone flap size of at least 12 cm in AP diameter for adequate and sustained ICP control.

背景本研究旨在评估中重度创伤性脑损伤后单侧额颞顶叶DC硬膜扩张术引起的ICP变化。方法 52 名有临床和放射学证据显示 ICP 增高的 TBI 患者被纳入这项前瞻性研究。所有患者都接受了单侧额颞顶叶 DC，并在对侧 Kocher 点进行了硬脑膜扩张和脑室造口术。术后测量了ICP值和切除骨瓣的最大前后（AP）直径，并在出院时和DC术后6个月使用扩展格拉斯哥结果量表（GOS-E）评估了临床结果。所有组的 ICP 变化相似。本研究还发现，与小骨瓣组（AP 直径 12-15 厘米）相比，大骨瓣组（AP 直径 15 厘米）的术后 ICP 控制更好，但无统计学意义。结论无论颅内病变情况如何，接受单侧前颞顶叶 DC 加硬脑膜扩张术的中重度 TBI 患者的 ICP 都能按照减压步骤得到降低，而且手术过程中骨瓣的 AP 直径至少应为 12 厘米，这样才能充分、持续地控制 ICP。

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引用次数: 0

Using the modified frailty index as a predictor of complications in adults undergoing transforaminal interbody lumbar fusion 使用改良虚弱指数预测接受经椎间孔腰椎融合术的成人的并发症

Q1 Medicine

World Neurosurgery: X

Pub Date : 2024-09-21 DOI: 10.1016/j.wnsx.2024.100407

Momin M. Mohis , Simon G. Ammanuel , Cuong P. Luu , James A. Stadler

Objective

To correlate the operative characteristics and complications of transforaminal lumbar interbody fusion (TLIF) to patient frailty status for the first time in a multicenter study.

Methods

Using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database, all patients who underwent TLIF in 2015–2020 were filtered for their demographics, operative characteristics, and 30-day complication outcomes. Patients were stratified into 2 cohorts, low and high frailty, based on their modified frailty index 5 score. Univariate analysis was performed between the 2 cohorts for each collected variable, and multivariable analysis was performed to observe adjusted odds ratios (OR).

Results

The frail cohort experienced more unplanned readmission (4.3 vs 6.6 %, p < 0.001). During hospital stays, the frail cohort experienced more overall complications (9.8 vs 13.8 %, p < 0.001). In contrast to the low frailty cohort, the high frailty patients saw longer hospital stays (3.27 vs. 3.69 days, p < 0.001). The high frailty group saw more discharges to an institution beside their home (89.6 vs 77.9 %, p < 0.001). Rates of superficial and deep surgical site infection, organ space infection, wound dehiscence, reintubation, renal insufficiency, urinary tract infection, stroke, cardiac arrest, DVT, sepsis, and septic shock were not significantly different. Multivariable analyses showed high frailty status as an independent predictor of unplanned readmissions, major complications, and preventing discharge to home.

Conclusions

mFI-5 serves as an effective predictor of surgical outcomes following TLIF and independently predicts unplanned readmission, discharge to home, and major complications. Noninfectious outcomes were more likely to be significantly different between the high- and low frailty groups, while all infectious outcomes apart from superficial surgical site infection and pneumonia were not significantly different between the cohorts.

方法利用美国外科学院国家外科质量改进（ACS-NSQIP）数据库，筛选出 2015-2020 年接受 TLIF 手术的所有患者的人口统计学特征、手术特征和 30 天并发症结果。根据患者的改良虚弱指数 5 分值，将患者分为低虚弱和高虚弱两组。对收集到的每个变量在两个组群之间进行单变量分析，并进行多变量分析以观察调整后的几率比（OR）。在住院期间，体弱人群经历了更多的并发症（9.8% 对 13.8%，p <0.001）。与低体弱组相比，高体弱组患者的住院时间更长（3.27 天 vs. 3.69 天，p < 0.001）。高体弱组中有更多患者出院后被送往家附近的医疗机构（89.6% 对 77.9%，p <0.001）。浅表和深部手术部位感染、器官间隙感染、伤口裂开、再次插管、肾功能不全、尿路感染、中风、心脏骤停、深静脉血栓、败血症和脓毒性休克的发生率没有显著差异。多变量分析表明，高虚弱状态是非计划再入院、主要并发症和无法出院回家的独立预测因素。结论MFI-5可有效预测TLIF术后的手术结果，并可独立预测非计划再入院、出院回家和主要并发症。高体弱组和低体弱组之间的非感染性结果更有可能存在显著差异，而除浅表手术部位感染和肺炎之外的所有感染性结果在不同组别之间均无显著差异。

{"title":"Using the modified frailty index as a predictor of complications in adults undergoing transforaminal interbody lumbar fusion","authors":"Momin M. Mohis , Simon G. Ammanuel , Cuong P. Luu , James A. Stadler","doi":"10.1016/j.wnsx.2024.100407","DOIUrl":"10.1016/j.wnsx.2024.100407","url":null,"abstract":"<div><h3>Objective</h3><div>To correlate the operative characteristics and complications of transforaminal lumbar interbody fusion (TLIF) to patient frailty status for the first time in a multicenter study.</div></div><div><h3>Methods</h3><div>Using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database, all patients who underwent TLIF in 2015–2020 were filtered for their demographics, operative characteristics, and 30-day complication outcomes. Patients were stratified into 2 cohorts, low and high frailty, based on their modified frailty index 5 score. Univariate analysis was performed between the 2 cohorts for each collected variable, and multivariable analysis was performed to observe adjusted odds ratios (OR).</div></div><div><h3>Results</h3><div>The frail cohort experienced more unplanned readmission (4.3 vs 6.6 %, <em>p</em> < 0.001). During hospital stays, the frail cohort experienced more overall complications (9.8 vs 13.8 %, <em>p</em> < 0.001). In contrast to the low frailty cohort, the high frailty patients saw longer hospital stays (3.27 vs. 3.69 days, <em>p</em> < 0.001). The high frailty group saw more discharges to an institution beside their home (89.6 vs 77.9 %, <em>p</em> < 0.001). Rates of superficial and deep surgical site infection, organ space infection, wound dehiscence, reintubation, renal insufficiency, urinary tract infection, stroke, cardiac arrest, DVT, sepsis, and septic shock were not significantly different. Multivariable analyses showed high frailty status as an independent predictor of unplanned readmissions, major complications, and preventing discharge to home.</div></div><div><h3>Conclusions</h3><div>mFI-5 serves as an effective predictor of surgical outcomes following TLIF and independently predicts unplanned readmission, discharge to home, and major complications. Noninfectious outcomes were more likely to be significantly different between the high- and low frailty groups, while all infectious outcomes apart from superficial surgical site infection and pneumonia were not significantly different between the cohorts.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100407"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416942","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}

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