Pub Date : 2019-01-01DOI: 10.26502/fjsrs.2687-8046003
Micah W. Smith, D. R. Romano
Atlantoaxial instability (AAI) is a common deformity in Down syndrome (DS). Although often inconsequential, AAI can progress to atlantoaxial rotatory subluxation (AARS). In patients with DS, concomitant AAI often necessitate surgical fusion, but successful stabilization in this population can be challenging due to high complication rates. A 14-year-old male with DS presented with a 3-month history of spontaneous AARS. After failed closed reduction, the parents consented to surgical stabilization. Preoperative planning revealed a high-riding vertebral artery and thin C2 lamina; therefore, C1-C4 segmental posterior instrumented fusion was performed, resulting in a successful reduction maintained at 12 months’ follow-up. The development of rigid fixation for the treatment of AARS has improved fusion rates in children with DS. However, vascular and osseous anomalies in this population often dictate extension of the fusion constructs beyond C1 and C2. Careful preoperative planning is a prerequisite to safe and solid fixation.
{"title":"Atlantoaxial Rotatory Instability in a Down Syndrome Patient with Aberrant Vertebral Artery Anatomy","authors":"Micah W. Smith, D. R. Romano","doi":"10.26502/fjsrs.2687-8046003","DOIUrl":"https://doi.org/10.26502/fjsrs.2687-8046003","url":null,"abstract":"Atlantoaxial instability (AAI) is a common deformity in Down syndrome (DS). Although often inconsequential, AAI can progress to atlantoaxial rotatory subluxation (AARS). In patients with DS, concomitant AAI often necessitate surgical fusion, but successful stabilization in this population can be challenging due to high complication rates. A 14-year-old male with DS presented with a 3-month history of spontaneous AARS. After failed closed reduction, the parents consented to surgical stabilization. Preoperative planning revealed a high-riding vertebral artery and thin C2 lamina; therefore, C1-C4 segmental posterior instrumented fusion was performed, resulting in a successful reduction maintained at 12 months’ follow-up. The development of rigid fixation for the treatment of AARS has improved fusion rates in children with DS. However, vascular and osseous anomalies in this population often dictate extension of the fusion constructs beyond C1 and C2. Careful preoperative planning is a prerequisite to safe and solid fixation.","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69347957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zachary Sanford, A. Broda, E. Keller, Justin J. Turcotte, C. Patton
Introduction: The following is a study of the impact of comorbid conditions on hospital length of stay following spinal fusion. Methods: Surgeries were identified from the 2016 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-US-NIS) by Medicare Severity Diagnosis Related Group (MS-DRG) codes and subdivided for analysis by fusion location and procedure approach. Length of stay was evaluated in relation to comorbid disease status, fusion location, and surgical technique. Comorbidities of interest included hypothyroidism, diabetes mellitus, hypertension, hyperlipidemia, anxiety, obesity, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, major depression, coronary atherosclerosis, arrhythmia, congestive heart failure, osteoporosis, stroke, and transient ischemic attack. Patients hospitalized longer than two months were excluded from this analysis. Results: 185,216 patients undergoing an inpatient spinal fusion were identified (Cervical 32,753, Cervicothoracic 2,633, Thoracic 2,817, Thoracolumbar 4,761, Lumbar 32,316, Lumbosacral 17,326). Each comorbid disease was found to significantly increase the length of hospital stay for at least one procedure location (p<.05), with transient ischemic attack (8.5 days in cervicothoracic cases), arrhythmia (5.4 days in thoracic cases), and chronic heart failure (4.8 days in cervicothoracic cases) associated with substantially increased duration of hospitalization. Chronic heart failure (β 2.85, SE 0.11, p <.001), stroke (β 3.05, SE 0.08, p <.001), and osteoarthritis (β 2.12, SE 0.41, p <.001) demonstrated strong positive association with increases in length of peroperative hospitalization. J Spine Res Surg 2019; 1 (2): 048-059 DOI: 10.26502/fjsrs008 Journal of Spine Research and Surgery 49 Conclusion: Preoperative comorbidities contribute variably to the length of post-spinal fusion hospital stay. With increasing trends towards predictive modeling in healthcare outcomes these conditions represent important factors for consideration in surgical planning.
简介:以下是一项关于合并症对脊柱融合术后住院时间影响的研究。方法:根据医疗保险严重程度诊断相关组(MS-DRG)代码从2016年医疗成本和利用项目国家住院患者样本(HCUP-US-NIS)中识别手术，并按融合位置和手术方法进行细分分析。住院时间与合并症状态、融合位置和手术技术有关。合并症包括甲状腺功能减退、糖尿病、高血压、高脂血症、焦虑、肥胖、慢性阻塞性肺病、骨关节炎、类风湿关节炎、重度抑郁症、冠状动脉粥样硬化、心律失常、充血性心力衰竭、骨质疏松症、中风和短暂性脑缺血发作。住院时间超过两个月的患者被排除在本分析之外。结果:185216例患者接受了住院脊柱融合术(颈32753例，颈胸2633例，胸2817例，胸腰椎4761例，腰椎32316例，腰骶17326例)。每一种合并症均显著增加至少一个手术部位的住院时间(p< 0.05)，短暂性脑缺血发作(颈胸病例8.5天)、心律失常(胸胸病例5.4天)和慢性心力衰竭(颈胸病例4.8天)与住院时间显著增加相关。慢性心力衰竭(β 2.85, SE 0.11, p <.001)、中风(β 3.05, SE 0.08, p <.001)和骨关节炎(β 2.12, SE 0.41, p <.001)与手术住院时间的增加呈显著正相关。中华外科杂志2019;结论:术前合并症对脊柱融合术后住院时间长短有不同的影响。随着医疗保健结果预测建模趋势的增加，这些条件代表了手术计划中需要考虑的重要因素。
{"title":"Impact of Comorbid Disease on Length of Hospitalization in Spine Fusion Patients: An HCUP-US-NIS Study","authors":"Zachary Sanford, A. Broda, E. Keller, Justin J. Turcotte, C. Patton","doi":"10.26502/fjsrs008","DOIUrl":"https://doi.org/10.26502/fjsrs008","url":null,"abstract":"Introduction: The following is a study of the impact of comorbid conditions on hospital length of stay following spinal fusion. Methods: Surgeries were identified from the 2016 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-US-NIS) by Medicare Severity Diagnosis Related Group (MS-DRG) codes and subdivided for analysis by fusion location and procedure approach. Length of stay was evaluated in relation to comorbid disease status, fusion location, and surgical technique. Comorbidities of interest included hypothyroidism, diabetes mellitus, hypertension, hyperlipidemia, anxiety, obesity, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, major depression, coronary atherosclerosis, arrhythmia, congestive heart failure, osteoporosis, stroke, and transient ischemic attack. Patients hospitalized longer than two months were excluded from this analysis. Results: 185,216 patients undergoing an inpatient spinal fusion were identified (Cervical 32,753, Cervicothoracic 2,633, Thoracic 2,817, Thoracolumbar 4,761, Lumbar 32,316, Lumbosacral 17,326). Each comorbid disease was found to significantly increase the length of hospital stay for at least one procedure location (p<.05), with transient ischemic attack (8.5 days in cervicothoracic cases), arrhythmia (5.4 days in thoracic cases), and chronic heart failure (4.8 days in cervicothoracic cases) associated with substantially increased duration of hospitalization. Chronic heart failure (β 2.85, SE 0.11, p <.001), stroke (β 3.05, SE 0.08, p <.001), and osteoarthritis (β 2.12, SE 0.41, p <.001) demonstrated strong positive association with increases in length of peroperative hospitalization. J Spine Res Surg 2019; 1 (2): 048-059 DOI: 10.26502/fjsrs008 Journal of Spine Research and Surgery 49 Conclusion: Preoperative comorbidities contribute variably to the length of post-spinal fusion hospital stay. With increasing trends towards predictive modeling in healthcare outcomes these conditions represent important factors for consideration in surgical planning.","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69348290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.26502/fjsrs.2687-8046001
M. Greenberg
{"title":"Preventing Alzheimer's","authors":"M. Greenberg","doi":"10.26502/fjsrs.2687-8046001","DOIUrl":"https://doi.org/10.26502/fjsrs.2687-8046001","url":null,"abstract":"","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69347911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.26502/fjsrs.2687-8046002
Sergio Eduardo Fischer Bulhoes, Gloria Maria Moraes Vianna da Rosa, Flavia Oliveira Toledo, Andrea Serra Granico
{"title":"Psychometric Factors in Quality of Life and Pain Perception in Patients with Chronic Nonspecific Neck Pain","authors":"Sergio Eduardo Fischer Bulhoes, Gloria Maria Moraes Vianna da Rosa, Flavia Oliveira Toledo, Andrea Serra Granico","doi":"10.26502/fjsrs.2687-8046002","DOIUrl":"https://doi.org/10.26502/fjsrs.2687-8046002","url":null,"abstract":"","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69347951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.26502/FJSRS.2687-8046007
I. J. Navarro, Jessica Secrieru, C. Candotti
Study design: This is a cross-sectional prospective study of diagnostic accuracy. Objective: The aim of this study was to establish the diagnostic accuracy and cut-off points of the surface topography parameters. Methods: Seventy-seven participants of both genders, aged between 7 and 18 years old, were consecutively included. Each participant was evaluated using two randomly-chosen consecutive procedures, by means of a surface topography scanner and a Scoliometer®. In this study, the angle of trunk rotation (ATR) determined using the Scoliometer® was taken as reference. For statistical purposes, a multiple linear regression analysis was made to establish which surface topography parameters have the highest standardized beta coefficients (β). Based on the β values, two topographic parameters were chosen (apex of the curve and trunk rotation) to compose the Receiver Operating Characteristic (ROC) analysis. Results: The cut-off points for the topographic parameters were established as ATR <5° for subjects without scoliosis and ≥8° for severe scoliosis. The ROC curve analysis for the apex of the curve was significant (p<0.001) with an area under the curve (AUC) ranging between 76% [cut-off point 4.4 mm] for the subjects without scoliosis and 84% [cut-off point 9.4 mm] for the subjects with severe scoliosis. For the trunk rotation parameter, the AUC was also significant, ranging between 68% [cut-off point 1.5°, p=0.023] for subjects without scoliosis, and 73% [cut-off point 4.8°, p=0.018] for the subjects with severe scoliosis. Conclusion: Surface topography provides adequate accuracy and can be used to evaluate the presence of the thoracic idiopathic scoliosis.
{"title":"Thoracic Idiopathic Scoliosis: Establishing the Diagnostic Accuracy and Reference Values of Surface Topography","authors":"I. J. Navarro, Jessica Secrieru, C. Candotti","doi":"10.26502/FJSRS.2687-8046007","DOIUrl":"https://doi.org/10.26502/FJSRS.2687-8046007","url":null,"abstract":"Study design: This is a cross-sectional prospective study of diagnostic accuracy. Objective: The aim of this study was to establish the diagnostic accuracy and cut-off points of the surface topography parameters. Methods: Seventy-seven participants of both genders, aged between 7 and 18 years old, were consecutively included. Each participant was evaluated using two randomly-chosen consecutive procedures, by means of a surface topography scanner and a Scoliometer®. In this study, the angle of trunk rotation (ATR) determined using the Scoliometer® was taken as reference. For statistical purposes, a multiple linear regression analysis was made to establish which surface topography parameters have the highest standardized beta coefficients (β). Based on the β values, two topographic parameters were chosen (apex of the curve and trunk rotation) to compose the Receiver Operating Characteristic (ROC) analysis. Results: The cut-off points for the topographic parameters were established as ATR <5° for subjects without scoliosis and ≥8° for severe scoliosis. The ROC curve analysis for the apex of the curve was significant (p<0.001) with an area under the curve (AUC) ranging between 76% [cut-off point 4.4 mm] for the subjects without scoliosis and 84% [cut-off point 9.4 mm] for the subjects with severe scoliosis. For the trunk rotation parameter, the AUC was also significant, ranging between 68% [cut-off point 1.5°, p=0.023] for subjects without scoliosis, and 73% [cut-off point 4.8°, p=0.018] for the subjects with severe scoliosis. Conclusion: Surface topography provides adequate accuracy and can be used to evaluate the presence of the thoracic idiopathic scoliosis.","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69347981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nora Conrads, Philipp Feldle, Timo Michael Heintel
Purpose: Pinpoint instrumentation is pivotal in cervical spine surgery in order to protect sensitive structures such as spinal cord or vertebral arteries. The aim of this study was to investigate the accuracy of neuro-navigated rotational fluoroscopy-guided screw positioning in the cervical spine employing a novel classification system. Methods: In procedures of dorsal cervical spine stabilization screw positions documented by rotational fluoroscopy were retrospectively evaluated. Accuracy of screw placement was analyzed using a new eight-grade scoring system with particular attention to the spinal canal, neuroforamina, and vertebral arteries. In addition, intra- and postoperative revision rates, as well as clinical and neurological outcome were evaluated. Results: One-hundred-forty-five patients with dorsal stabilization of the cervical spine were included. Of the 925 screws placed, 877 (94.8%) showed optimal positioning in the primary 3D image control. Differentiating between less and more than 50% of the screw diameter, 15 (1.6%) and 2 screws (0.2%) protruded into the transverse foramen. The pedicle or lateral mass were exceeded craniocaudally by 8 (≤50%: 0.9%) and 3 screws (>50%: 0.3%), respectively. Laterally, the pedicle or mass was exceeded substantially by 6 screws (0.6%). Medially, 8 (≤50%: 0.9%) vs. 6 screws (>50%: 0.6%) exceeded the wall of the pedicle or lateral mass. No patient underwent secondary surgery due to initial screw mispositioning. An improvement of the preoperatively indicated pain levels was documented in 87 of 114 patients (76.3%) with adequate follow-up. Conclusions
{"title":"Employment of 3D rotational fluoroscopy for neuro-navigated screw placement in the cervical spine","authors":"Nora Conrads, Philipp Feldle, Timo Michael Heintel","doi":"10.26502/fjsrs0050","DOIUrl":"https://doi.org/10.26502/fjsrs0050","url":null,"abstract":"Purpose: Pinpoint instrumentation is pivotal in cervical spine surgery in order to protect sensitive structures such as spinal cord or vertebral arteries. The aim of this study was to investigate the accuracy of neuro-navigated rotational fluoroscopy-guided screw positioning in the cervical spine employing a novel classification system. Methods: In procedures of dorsal cervical spine stabilization screw positions documented by rotational fluoroscopy were retrospectively evaluated. Accuracy of screw placement was analyzed using a new eight-grade scoring system with particular attention to the spinal canal, neuroforamina, and vertebral arteries. In addition, intra- and postoperative revision rates, as well as clinical and neurological outcome were evaluated. Results: One-hundred-forty-five patients with dorsal stabilization of the cervical spine were included. Of the 925 screws placed, 877 (94.8%) showed optimal positioning in the primary 3D image control. Differentiating between less and more than 50% of the screw diameter, 15 (1.6%) and 2 screws (0.2%) protruded into the transverse foramen. The pedicle or lateral mass were exceeded craniocaudally by 8 (≤50%: 0.9%) and 3 screws (>50%: 0.3%), respectively. Laterally, the pedicle or mass was exceeded substantially by 6 screws (0.6%). Medially, 8 (≤50%: 0.9%) vs. 6 screws (>50%: 0.6%) exceeded the wall of the pedicle or lateral mass. No patient underwent secondary surgery due to initial screw mispositioning. An improvement of the preoperatively indicated pain levels was documented in 87 of 114 patients (76.3%) with adequate follow-up. Conclusions","PeriodicalId":73951,"journal":{"name":"Journal of spine research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69348179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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