The predictive factors associated with neck pain remain unclear. We conducted a cross-sectional study to assess predictive factors, especially Modic changes (MCs), associated with the intensity and duration of neck pain in patients with cervical disc degenerative disease.We retrospectively reviewed patients in our hospital from January 2013 to December 2016. Severe neck pain (SNP) and persistent neck pain (PNP) were the 2 main outcomes, and were assessed based on the numerical rating scale (NRS). Basic data, and also imaging data, were collected and analyzed as potential predictive factors. Univariate analysis and multiple logistic regression analysis were performed to assess the predictive factors for neck pain.In all, 381 patients (193 males and 188 females) with cervical degenerative disease were included in our study. The number of patients with SNP and PNP were 94 (24.67%) and 109 (28.61%), respectively. The NRS of neck pain in patients with type 1 MCs was significantly higher than type 2 MCs (4.8 ± 0.9 vs 3.9 ± 1.1; P = .004). The multivariate logistic analysis showed that kyphosis curvature (odds ratio [OR] 1.082, 95% confidence interval [CI] 1.044-1.112), spondylolisthesis (OR 1.339, 95% CI 1.226-1.462), and annular tear (OR 1.188, 95% CI 1.021-1.382) were factors associated with SNP, whereas kyphosis curvature (OR 1.568, 95% CI 1.022-2.394), spondylolisthesis (OR 1.486, 95% CI 1.082-2.041), and MCs (OR 1.152, 95% CI 1.074-1.234) were associated with PNP.We concluded that kyphosis curvature, spondylolisthesis, and annular tear are associated with SNP, whereas kyphosis curvature, spondylolisthesis, and MCs are associated with PNP. This study supports the view that MCs can lead to a long duration of neck pain.
Neck Pain (9), Kyphosis (5), Spondylolisthesis (5), more mentions
... the study was to explore surgical strategies for effectively treating spinefractures in patients with ankylosing spondylitis (AS) and investigate the postoperative ... retrospectively analyzed 9 patients with AS that was complicated by spinefractures, who underwent surgery at our spine and spinal cord clinic ... instrumentation with bone grafting was a satisfying method for treating spinefractures in patients with AS.
DescriptorName: Sensitivity and Specificity. DescriptorName: SpinalStenosis. Abstract: The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) has been shown to be useful in predicting postoperative complications. In this study, we aimed to evaluate the predictive value of the ACS-NSQIP calculator in geriatric patients undergoing lumbar surgery.A total of 242 geriatric ...
Spinal Stenosis (1), Dyspnea (1), Kidney Failure (1), more mentions
AbstractText: To identify the effects of hormone replacement therapy (HRT) on spinalosteoarthritis (OA) AbstractText: A cross-sectional study of a nationwide survey was performed AbstractText: This study collected data from the fifth Korean National Health and Nutrition Examination Survey (2010-2012) AbstractText: After excluding ineligible respondents, the total number ...
Muscular and Skeletal Diseases (3) Spine Osteoarthritis (2), Osteoarthritis (1), more mentions
... cohort study AbstractText: One hundred and eleven patients with MESCC who underwent separation surgery followed by SRS were included AbstractText: Prognostic factors associated with improved patient reported outcome (PRO) measures AbstractText: PRO tools, i.e. Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory - SpineTumor (MDASI-SP), both validated in the cancer population, were prospectively collected... Keyword: Spinetumor.
Oncology (1) Neoplasms (6), Spinal Cord Compression (1), more mentions
... factors that may influence health outcomes among those with a spinalinjury have not been extensively examined at a population-level AbstractText: To describe the characteristics of traumatic spinalinjury, identify factors predictive of mortality; and estimate the cost of ... and hospitalisation costs AbstractText: Hospitalisations with a principal diagnosis of spinal cord injury or spinalfractures were used to identify traumatic spinalinjuries ...
RATIONALE: Renal complications in ankylosing spondylitis (AS) were rarely observed, and proteinuria associated with AS can be seen often due to amyloidosis in this kind of complications, while membranous nephropathy (MN) is seldom considered. This article reports a case of coexistence of AS and MN, to provide the exact relationship of these 2 entities and recognized some causes of renal involvement in AS.
PATIENT CONCERNS: A 44-year-old female presented with pain of the left leg for 4 years and pedal edema for 2 weeks.
DIAGNOSES: AS was diagnosed according to the patient's clinical manifestation and sacroiliitis observed on computed tomography (CT) scan. Nephrotic syndrome was found and MN was diagnosed according to kidney biopsy in which thickened capillary loops were observed with light microscopy, granular deposits of IgG along the capillary wall were observed using immunofluorescence staining, and subepithelial electron-dense deposits were observed with electron microscopy. No other secondary causes of MN were found on extensive investigations.
INTERVENTION: Given the diagnoses, the patient received nonimmunosuppressive therapy for MN and adalimumab for AS.
OUTCOMES: The patient got pain relief, as well as urinary protein reduction.
LESSONS: This case suggested a secondary MN in association with AS and the relationship between these 2 diseases needed more concern and further illumination.
Membranous Glomerulonephritis (2), Ankylosing Spondylitis (2), Amyloidosis (1), more mentions
BACKGROUND CONTEXT: Cerebrolysin(®) is a mixture containing 85% free amino acids and 15% biologically active low-molecular weight peptides, that is believed to mimic the effects of endogenous neurotrophic factors to interact with the pathological process cascade of neurodegenerative diseases. No study has examined the effect of Cerebrolysin(®) on the cervical myelopathic patients.
PURPOSE: To evaluate the effect of cerebrolysin(®) as a conservative modality on cervical spondylotic myelopathic patients.
STUDY DESIGN: Prospective randomized study.
PATIENT SAMPLE: 192 patients with cervical spondylotic myelopathy (CSM) were subdivided blindly into 2 equal groups.
OUTCOME MEASURES: followed up at 1, 3 and 6 months comparing the recovery rate Japanese orthopaedic association (JOA) score for cervical myelopathy between the two groups.
METHODS: group I received cerebrolysin and group II received placebo for 4 weeks, both groups received celecoxib 200 mg for 4 week.
CONFLICT OF INTEREST: All the authors declare that they have no conflict of interest.
FUNDING SOURCE: No disclosure of funding received for this work from any organization.
RESULTS: Myelopathy improved in 92% and 52% of patients at 1 month in group I and II respectively, these were changed at 6 months to 87% and 33%, the remaining 13 % in group I were not improved nor deteriorated, while in group II 60% not improved nor deteriorated and 7% were deteriorated with statistically significant differences when comparing the mean JOA recovery rates % between the 2 groups at 1, 3 and 6 months CONCLUSION: Cerebrolysin(®) over 4 weeks is safe and effective for improvement of cervical spondylotic myelopathy as compared to placebo with no reported cases of neurological deterioration over 6 month follow up.
BACKGROUND CONTEXT: The Rothman Index (RI) is a comprehensive rating of overall patient condition in the hospital setting. It is used at many medical centers and calculated based on vital signs, lab values, and nursing assessments in the electronic medical record. Past research has demonstrated an association with adverse events, readmission, and mortality in other fields, but it has not been investigated in spine surgery.
PURPOSE: To determine the potential utility of the RI as a predictor of adverse events after discharge following elective spine surgery.
STUDY DESIGN/SETTING: Retrospective cohort study at a large academic medical center.
PATIENT SAMPLE: 2,687 patients who underwent elective spine surgery between 2013 and 2016.
OUTCOME MEASURES: The occurrence of adverse events and readmission after discharge from the hospital, within postoperative day 30.
METHODS: Patient characteristics and 30-day perioperative outcomes were characterized, with events being classified as "major adverse events" or "minor adverse events" using standardized criteria. RI scores from the hospitalization were analyzed and compared for those who did or did not experience adverse events after discharge. The association of lowest and latest scores on adverse events was determined with multivariate regression, controlling for demographics, comorbidities, surgical procedure, and length of stay.
RESULTS: Post-discharge adverse events were experienced by 7.1% of patients. The latest and lowest RI values were significantly inversely correlated with any adverse events, major adverse events, minor adverse events and readmissions after controlling for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, surgical site, and hospital length of stay. Rates of readmission and any adverse event consistently had an inverse correlation with lowest and latest RI scores, with patients at increased risk with lowest score below 65 or latest score below 85.
CONCLUSIONS: The Rothman Index is a tool that can be used to predict post-discharge adverse events following elective spine surgery that adds value to commonly used indices such as patient demographics and ASA. It is found that this can help physicians identify high-risk patients prior to discharge and should be able to better inform clinical decisions.
BACKGROUND CONTEXT: Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The BMI threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood.
PURPOSE: Identify the body mass index (BMI) that independently predicts risk of postoperative complications following lumbar spine surgery.
STUDY DESIGN/SETTING: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013.
PATIENT SAMPLE: There were 31,763 patients undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, and/or osteotomy of the lumbar spine.
OUTCOME MEASURES: Complication rates.
METHODS: The patient sample was categorized pre-operatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal-overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into Low-SII and High-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni ANOVA method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in High-SII and Low-SII surgeries.
RESULTS: Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (OR [95% CI]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<0.05).
CONCLUSIONS: There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.
Anti-Obesity and Weight Loss (15), Cardiovascular Diseases (1), Endocrine Disorders (1) Obesity (11), Infections (2), Hypertension (1), more mentions
BACKGROUND CONTEXT: During placement of C2 pedicle and pars screws, intraoperative fluoroscopy is used so that neurovascular complications can be avoided, and screws can be placed in the proper position. However, this method is time consuming and increases radiation exposure. Furthermore, it does not guarantee completely safe and accurate screw placement.
PURPOSE: To evaluate the safety of the C2 pedicle and pars screw placement without fluoroscopic or other guidance methods.
STUDY DESIGN: Retrospective comparative study.
PATIENT SAMPLE: One hundred and ninety-eight patients who underwent placement of C2 pedicle or pars screws without any intraoperative radiographic guidance were included.
OUTCOME MEASURES: Medical records and postoperative CT scans were evaluated.
METHODS: Clinical data were reviewed for intraoperative and postoperative complications. Accuracy of screw placement was evaluated with post-op CT scans using a previously published cortical-breach grading system (described by location and percentage of screw diameter over cortical edge (0 = none; grade I = < 25% of screw diameter; grade II = 26-50%; grade III = 51-75%; and grade IV = 76-100%)).
RESULTS: 148 pedicle and 219 pars screws were inserted by two experienced surgeons. There were no cases of CSF leakage and no neurovascular complications during screw placement. Postoperative CT scans were available for 76 patients, which included 52 pedicle and 87 pars screws. For cases with C2 pedicle screws, there were 12 breaches (23%); these included 10 screws with a grade I breach (19%), 1 screw with a grade II breach (2%), and 1 screw with a grade IV breach (2%). Lateral breaches occurred in 7 screws (13%), inferior breaches in 3 (6%), and superior breaches in 2 (4%). For cases with C2 pars screws, there were 10 breaches (11%); these included 6 screws with a grade I breach (7%), 2 screws with a grade II breach (2%), and 2 screws with a grade IV breach (2%). Medial breaches were found in 4 (5%), lateral breaches in 2 (2%), inferior breaches in 2 (2%), and superior breaches in 2 (2%). 2 of the cases with superior breaches (1 for pedicle and 1 for pars) experienced occipital neuralgia months after surgery. There was no statistically significant difference in incidence of overall and high-grade breaches between the groups (p = 0.07 and 1 respectively).
CONCLUSIONS: Although even in experienced hands up to 23% of C2 pedicle screws and 11% C2 pars screws placed using a freehand technique without guidance may be malpositioned, a clear majority of malpositioned screws demonstrated a low-grade breach and only 2 of 198 patients (1%) experienced complications related to screw placement.
Excised herniateddisc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification... The primary endpoint is the rate of disc infection in patients with symptomatic degenerativedisc disease. The secondary endpoints will be performance scores, Modic incidence and volume AbstractText: This study was approved by our Institutional Review ...
INTRODUCTION: Patients with symptomatic spondylolisthesis are frequently treated with nerve root decompression, in addition to pedicle screw fixation and interbody fusion. Minimally invasive approaches are gaining attention in recent years, although there is no clear evidence supporting the proclamation of minimally invasive spine surgery (MISS) being better than open surgery. We present the design of the MISOS (Minimal Invasive Surgery versus Open Surgery) trial on the effectiveness of MISS versus open surgery in patients with degenerative or spondylolytic spondylolisthesis.
METHODS AND ANALYSIS: All patients (age 18-75 years) with neurogenic claudication or radicular leg pain based on low-grade degenerative or spondylolytic spondylolisthesis with persistent complaints for at least 3 months are eligible. Patients will be randomised into mini-open decompression with bilateral interbody fusion with percutaneous pedicle screw fixation (MISS), or conventional surgery with decompression and instrumented fusion with pedicle screws and bilateral interbody fusion (open). The primary outcome measure is Visual Analogue Scale of self-reported low back pain. Secondary outcome measures include improvement of leg pain, Oswestry Disability Index, patients' perceived recovery, quality of life, resumption of work, complications, blood loss, length of hospital stay, incidence of reoperations and documentation of fusion. This study is designed as a multicentre, randomised controlled trial in which two surgical techniques are compared in a parallel group design. Based on a 20 mm difference of low back pain score at 6 weeks (power of 90%, assuming 8% loss to follow-up), a total of 184 patients will be needed. All analyses will be performed according to the intention-to-treat principle.
ETHICS AND DISSEMINATION: The study has been approved by the Medical Ethical Review Board Southwest Holland in August 2014 (registration number NL 49044.098.14) and subsequently approved by the board of all participating hospitals. Dissemination will include peer-reviewed publications and presentations at national and international conferences.
TRIAL REGISTRATION NUMBER: NTR 4532, pre-results.
BACKGROUND CONTEXT: The typically accepted surgical procedure for cervical disc pathology has been the anterior cervical discectomy and fusion (ACDF), although recent trials have demonstrated equivalent or improved outcomes with cervical disc arthroplasty (CDA). Trends for these two procedures regarding utilization, revision procedures, along with other demographic information have not been sufficiently explored.
PURPOSE: To provide data regarding ACDF and CDA from 2006-2013 in the U.S.
DESIGN: Retrospective national database analysis.
PATIENT SAMPLE: 20% sample of discharges from U.S. hospitals, which is weighted to provide national estimates.
OUTCOME MEASURES: Functional measures such as national incidence, hospital costs, length of stay (LOS), routine discharge, revision burden, and patient characteristics.
METHODS: Patients from the National Inpatient Sample (NIS) database who underwent primary ACDF, revision ACDF, primary CDA, and revision CDA from 2006-2013 were included. Demographic and economic data for the procedures' respective ICD-9 CM codes were collected.
RESULTS: 1,059,403 ACDF and 13,099 CDA surgeries were performed in the U.S. from 2006-2013. The annual number of ACDF increased 5.7% non-linearly from 120,617 in 2006 to 127,500 in 2013 (mean per year: 132,425; range: 120,617-147,966); CDA increased 190% non-linearly from 540 in 2006 to 1,565 in 2013 (mean per year: 1,637; range: 540-2,381). CDA patients were younger and had more private or 'other' insurance, including worker's compensation (p<0.0001). Mean LOS was longer for ACDF (ACDF 2.3 days vs. CDA 1.5; p<0.0001). Routine discharge was higher in the CDA group (CDA 96% vs. ACDF 89%; p-value<0.0001). The mean hospital-related cost was more expensive for ACDF (ACDF $16,178 vs. CDA $13,197; p-value=0.0007). CDA mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was greater (CDA 5.9% vs. ACDF 2.3%, p-value=0.01).
CONCLUSIONS: Nationally approximately 132,000 ACDFs are done each year compared to only 1,600 CDAs. The number of ACDF surgeries performed far outpaces CDA by a ratio of 81:1 in the U.S. without a clear direction in the trend for utilization given recent fluctuations. CDA revision burden was more than double compared to the ACDF revision burden (5.9% vs 2.3%), which was not accounted for by patient baseline demographics. The etiology of these findings are likely multifactorial and require further research.
AbstractText: To compare the CT Syndesmophyte Score (CTSS) for low-dose CT (ldCT) with the modified Stoke Ankylosing SpondylitisSpine Score (mSASSS) for conventional radiographs (CR) in patients with ankylosing spondylitis (AS) AbstractText: Patients with AS in the Sensitive Imaging ... Most progression occurred in the thoracic spine Keyword: ankylosing spondylitis.
... spine change score ICC was 0.77 and 0.32-0.75 for spinal segments. Whole-spine SDC was 14.4. Score distribution pattern per VU was similar between readers AbstractText: Using the CTSS, new bone formation in the spine of patients with AS can be assessed reliably. Most progression was seen in the thoracic spine Keyword: ankylosing spondylitis. Keyword: outcomes research. Keyword: spondyloarthritis.
OBJECTIVES: Lack of response to TNF inhibitory (TNFi) agents is not uncommon, encountered during the treatment of axial spondyloarthritis (AxSpA) patients and can be classified as primary (PLR) or secondary (SLR) lack of response. The primary aim of this study was to evaluate factors associated with TNFi failure types and their characteristics in AxSpA.
METHODS: Adult AxSpA patients who were TNFi naive at the time of baseline evaluation and started on their first biologics for active axial disease were identified. Based on the clinical response to the first TNFi, patients were then stratified into the three groups: PLR, SLR, and responders. Clinical, demographic and laboratory data were collected and analyzed.
RESULTS: There were a total of 249 (70.7% male [M], 37.3±12.4 years of age) axial SpA patients in the study, which included PLR (n=62), SLR (n=93) and responders (n=94). PLR patients tended to be older, with a lower HLA-B27 rate, a higher percentage of nr-AxSpA patients and a higher baseline BASDAI score compared to SLR or responders. In multiple regression analysis, increasing age, negative HLA-B27, higher baseline BASDAI, and treatment with the soluble TNF receptor protein were the independent predictors of PLR.
CONCLUSIONS: Primary lack of response accounted nearly 40% of the TNFi failures in AxSpA patients. Older age, negative HLA-B27, higher baseline disease activity and treatment with sTNFR were the independent predictors of the primary non-response to TNFi. This article is protected by copyright. All rights reserved.
Necrosis (1), Ankylosing Spondylitis (1), Spondylarthropathies (1), more mentions
... fistulas (SEAVFs) and spinal dural arteriovenous fistulas (SDAVFs) of the thoracolumbarspine AbstractText: A total of 168 cases diagnosed as spinal dural or extradural arteriovenous fistulas of the thoracolumbarspine were collected from 31 centers ... A history of spinalinjury/surgery was more frequently found in SEAVFs (36%) than in ...
OBJECTIVE: The purpose of this study was to review the available armamentarium and most recent advances in minimally invasive, image-guided percutaneous thermal ablation for treatment of spinal metastases.
CONCLUSION: Minimally invasive percutaneous spine thermal ablation technologies have proved safe and effective in management of selected patients with spinal metastases. Special attention to procedure techniques including choice of ablation modality, thermoprotection, adequacy of treatment, and postablation imaging is essential for improved patient outcomes.