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
... surgical time, fewer postoperative complications, and shorter hospital stay than the patients underwent anterior debridement with posterior instrumentation.The results suggested that treating thoracic spondylodiscitis with a single-stage posterior approach might prevent postoperative complications and avoid respiratory problems associated with anterior approaches. Single-stage posterior approaches would be recommended for thoracic spineinfection, especially for patients with medical comorbidities.
Discitis (4), Infections (3), Central Nervous System Infections (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
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
Paraoxonase 1 (PON1) modulates the oxidative stress and inflammatory response, thus, it might relate to the risk of ankylosing spondylitis (AS). The aim of present study was to discover the correlation of PON1 polymorphisms (rs662 and rs854560) with PON1 activity and AS risk.Around 128 AS patients and 146 healthy controls were recruited in this case-control study. PON1 polymorphisms were genotyped by direct sequencing. Serum PON1 activity was detected and compared by nonparametric test in different genotypes of PON1 polymorphisms. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to present the relative risk for AS.GG genotype and G allele of rs662 polymorphism were closely correlated with enhanced AS risk (P = .034, OR = 2.318, 95%CI = 1.051-5.113; P = .032, OR = 1.485, 95%CI = 1.033-2.135). PON1 activity was obviously higher in controls than that in AS patients. Significant difference of PON1 activity has been discovered in the different rs662 genotypes (P < .01). rs662 GG genotype carriers had the lowest PON1 activity, followed by AG carriers and the AA carriers. Besides, no significant relationship existed between rs854560 genotypes and AS risk.PON1 rs662 polymorphism is significantly correlated with increased AS risk via inhibiting PON1 activity.
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.
Substantial evidence at the subcellular level indicates that the spatial arrangement of synaptic inputs onto dendrites could play a significant role in cortical computations, but how synapses of functionally defined cortical networks are arranged within the dendrites of individual neurons remains unclear. Here we assessed one-dimensional spatial receptive fields of individual dendritic spines within individual layer 2/3 neuron dendrites. Spatial receptive field properties of dendritic spines were strikingly diverse, with no evidence of large-scale topographic organization. At a fine scale, organization was evident: neighboring spines separated by less than 10 μm shared similar spatial receptive field properties and exhibited a distance-dependent correlation in sensory-driven and spontaneous activity patterns. Fine-scale dendritic organization was supported by the fact that functional groups of spines defined by dimensionality reduction of receptive field properties exhibited non-random dendritic clustering. Our results demonstrate that functional synaptic clustering is a robust feature existing at a local spatial scale.
OBJECTIVES: To develop and validate an outcome measure for assessing fears in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA).
METHODS: Fears were identified in a qualitative study, and reformulated as assertions with which participants could rate their agreement (on a 0-10 numeric rating scale). A cross-sectional validation study was performed including patients diagnosed with RA or axSpA. Redundant items (correlation >0.65) were excluded. Internal consistency (Cronbach's α) and factorial structure (principal component analysis) were assessed. Patients were classified into fear levels (cluster analysis). Associations between patient variables and fear levels were evaluated using multiple logistic regression.
RESULTS: 672 patients were included in the validation study (432 RA, 240 axSpA); most had moderate disease activity and were prescribed biologics. The final questionnaire included 10 questions with high internal consistency (α: 0.89) and a single dimension. Mean scores (±SD) were 51.2 (±25.4) in RA and 60.5 (±22.9) in axSpA. Groups of patients with high (17.2%), moderate (41.1%) and low (41.7%) fear scores were identified. High fear scores were associated with high Arthritis Helplessness Index scores (OR 6.85, 95% CI (3.95 to 11.87)); high Hospital Anxiety and Depression Scale anxiety (OR 5.80, 95% CI (1.19 to 4.22)) and depression (OR 2.37, 95% CI (1.29 to 4.37)) scores; low education level (OR 3.48, 95% CI (1.37 to 8.83)); and high perceived disease activity (OR 2.36, 95% CI (1.10 to 5.04)).
CONCLUSIONS: Overall, 17.2% of patients had high fear scores, although disease was often well controlled. High fear scores were associated with psychological distress. This questionnaire could be useful both in routine practice and clinical trials.
Immune System Diseases (3), Muscular and Skeletal Diseases (1) Rheumatoid Arthritis (3), Ankylosing Spondylitis (1), Rheumatic Diseases (1), more mentions
Objective: Minimally invasive percutaneous spinal procedures are popular in trying to reduce spinal pain. The aim of this paper is to evaluate the safety of intervertebral disc chemonucleolysis and to report the effectiveness of a percutaneous, minimally invasive treatment for contained herniated intervertebral discs in the lumbar spine using the recently marketed radiopaque gelified ethanol.
Methods: Pain relief before and after the procedure was self-evaluated by each patient using a verbal numeric scale (VNS) ranging from 0 to 10. Patients were also scored prior to procedure and after chemonucleolysis during several follow-up periods using the Roland-Morris low back pain and disability questionnaire (RMQ). Follow-up periods were defined as 0-6, 6-12, 12-18, 18-24, and 24-30 months. Clinically significant functional improvement (CSFI) was defined as a decrease of five or more points on the RMQ scale and a decrease of at least 50% of pain intensity using VNS.
Results: Using the RMQ scale, CSFI was achieved in 20/29 patients in the first follow-up period, 20/27 patients in the second follow-up period, 9/12 patients in the third follow-up period, 8/9 patients in the fourth follow-up period, and 4/4 patients in the last follow-up period. Using the VNS rating, CSFI was accomplished in 19/29 patients in the first follow-up period, 19/27 patients in the second follow-up period, 9/12 patients in the third follow-up period, 8/9 patients in the fourth follow-up period, and 4/4 in the last follow-up period.
Conclusions: Intradiscal application of gelified ethanol may be effective in pain reduction using the VNS and Roland-Morris low back pain and disability questionnaire. The treatment is safe and easy to handle.
Four of 192 treatments (2%) demonstrated local tumor recurrence or progression at the time of analysis. Of the 4 local failures, 1 patient had kyphoplasty prior to SRS. This recurrence occurred 18 months after SRS in the setting of widespread systemic disease and spinaltumor progression... Keyword: spinetumors. Keyword: stereotactic radiosurgery.
Oncology (2) Neoplasms (7), Spinal Cord Compression (1), more mentions
BACKGROUND CONTEXT: The Load Sharing Classification (LSC) laid foundations for a scoring system able to indicate which thoracolumbar fractures, after short-segment posterior-only fixations, would need for longer instrumentations or additional anterior supports.
PURPOSE: We analyzed surgically treated thoracolumbar fractures, quantifying the vertebral body's fragments displacement with the aim of identifying a new parameter which could predict the posterior-only construct failure.
STUDY DESIGN: Retrospective cohort/single institution.
PATIENT SAMPLE: One hundred twenty-one consecutive patients surgically treated for thoracolumbar burst fractures.
OUTCOME MEASURES: Grade of Kyphosis Correction (GKC) expressed radiological outcome; Oswestry Disability Index and Visual Analogue Scale (VAS) were considered.
METHODS: One hundred twenty-one consecutive patients who underwent posterior fixation for unstable thoracolumbar burst fractures were retrospectively evaluated clinically and radiologically. Supplementary anterior fixations were performed in thirty-four cases with posterior instrumentation failure, determined on clinic-radiological evidences or symptomatic loss of kyphosis correction. Segmental kyphosis angle and GKC were calculated according to the Cobb method. The displacement of fracture fragments was obtained from the mean of the adjacent endplates areas subtracted to the area enclosed by the maximum contour of vertebral fragmentation. The "spread", derived from the ratio between this subtraction and the mean of the adjacent endplates areas. ANOVA, Mann-Whitney and ROC were performed for statistical analysis. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. No funds or grants have been received for this study.
RESULTS: The spread revealed to be a helpful quantitative measurement of vertebral body fragments displacement, easily reproducible with the current CT imaging technologies. There were no failures of posterior fixations with preoperative spreads <42% and losses of correction (LOC) <10°, while spreads >62.7% required supplementary anterior supports whenever LOC>10° were recorded. Most of the patients in a "grey zone", with spreads between 42% and 62.7%, needed additional anterior supports because of clinical-radiological evidences of impending mechanical failures which developed independently from the GKC. Preoperative kyphosis (p<.001), LSS (p=.002) and spread (p<.001) significantly affected the final surgical treatment (posterior or circumferential).
CONCLUSIONS: Twenty-two years after the LSC both improvements in spinal stabilization systems and software imaging innovations have modified surgical concepts and approach regarding spinal trauma care. Spread was found to be an additional tool which could help in predicting the posterior construct failure, providing an objective preoperative indicator, easily reproducible with the modern viewers for CT images.