Journal of Spinal Disorders & Techniques最新文献

{"title":"Dexamethasone Perioperative Coanalgesia in Lumbar Spine Fusion: A Controlled Cohort Study of Efficacy and Safety.","authors":"Drew A Bednar, Arthur Wong, Forough Farrokhyar, James Paul","doi":"10.1097/BSD.0b013e3182a1ddd3","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a1ddd3","url":null,"abstract":"Purpose: A 48-hour trial of dexamethasone coanalgesia became our standard practice in May 2008. This is our research Ethics Board–approved review of this experience to date with attention to perioperative narcotics use and pain scores for the first 48 hours after surgery as well as length of stay (LOS), wound healing complications, and infections in the first 6 months, compared with the historical precedent control cohort. Methods: Surgical case logs identified cases of 1- and 2-level elective lumbar decompression and fusion surgery performed since protocol initiation (cases) and for a like period beforehand (controls). Minimum of 6 months follow-up (sufficient to identify acute and subacute wound healing problems and perioperative infections) information was required. Hospital, Pain Service, and office records were reviewed for the extraction of outcomes data. Results: We identified 132 cases and 146 controls. In 41 additional cases records were deficient. Baseline characteristics were equivalent. Cases included 70 males (53%) and 62 females (47%) of mean age 54 years (range, 18–84 y). Seventy-five (57%) cases were narcotics dependant (mean of 79.5 mg-morphine-equivalent daily). Controls included 78 males (53%) and 68 females (47%) of mean age 55 years (range, 27–85 y). Eighty-nine (61%) controls were narcotics dependant (mean 101.2 mg-morphine-equivalents daily). Mean morphine-equivalents narcotic consumption for 48 hours after surgery was 262.9 mg in cases and 280.7 mg in controls. VAS pain scores at 48 hours after surgery averaged 4.4 and 6.9 during rest and activity in the cases, and 3.7 and 6.3 during rest and activity in the controls. LOS averaged 3.9 days in cases and 5.2 days in controls. Delayed wound healing and surgical site infections were not observed in either group. Conclusions: Systemic dexamethasone after 1- and 2-level lumbar fusion surgery demonstrated minimal impact on 48 hours perioperative narcotics use with no detriment to pain control, wound healing, or infections. LOS was shortened by 25%.","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E422-6"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a1ddd3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33870864","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}

{"title":"Epidural Injections for Spinal Stenosis.","authors":"Barrett I Woods, Kristen Radcliff, Jesse Bible, Joon Lee","doi":"10.1097/BSD.0000000000000303","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000303","url":null,"abstract":"Epidural steroid injections (ESIs) are a common treatment for various types of lumbar spine pathology. Although ESI have been shown to contribute to successful nonoperative treatment in some patients with lumbar disk herniation, there is little evidence to suggest ESI alters the natural history of spinal stenosis or facilitates surgical avoidance.2 In this debate, we will argue that there is no role for ESI in the treatment of lumbar stenosis from a biological or clinical perspective. The biological rational for ESI in patients with chronic spinal stenosis is not concordant with the underlying pathophysiology of this disease process. Acute stenosis secondary to a disk herniation may have an inflammatory component that responds to ESI resulting in short-term benefit. This theory is supported by the SPORT subgroup analysis of lumbar disk herniation, which showed increased surgical avoidance in patients who received ESI but no difference in outcome measures between either group at 4 years.3 Unlike stenosis caused by disk herniation, biological mechanisms for resorption of osseous or ligamentous structures causing neural impingement do not exist. Chronic lumbar stenosis is likely symptomatic due to ischemic or vascular phenomena, not inflammation. Laboratory markers of inflammation are not uniformly elevated in patients with symptomatic lumbar stenosis either in the serum or in the epidural space. Prospective randomized control trials have shown no significant benefit of ESI over anesthetic or saline injections in patients with lumbar stenosis.4,5 Also there is concern regarding the potential deleterious systemic and local effect repetitive exposure to steroids can have on these patients, such as hyperglycemia, weight gain, epidural lipomatosis, or exacerbation of osteoporosis.6 Exposing the nerve roots of the cauda equina to epidural steroids in the setting of spinal stenosis may adversely affect neurological outcome. Radcliff et al,7 reported patients with lumbar spinal stenosis who received ESI had significantly less improvement at 4 years than patients without exposure to steroids in both the surgical and nonsurgical treatment groups. There is a growing body of clinical literature challenging the efficacy of ESI in patients with spinal stenosis. Despite this, ESIs are commonly administered to spinal stenosis patients and account for approximately 25% of all ESI in Medicare patients and 75% of patients who receive ESI in the Veterans Affairs system.8,9 The contention that ESI can facilitate surgical avoidance in patients with spinal stenosis is not supported clinically, as ESI are now often a prerequisite for surgical intervention. There is also a high correlation between ESI and increased rates of surgery for spinal stenosis in empirical databases.10 Finally, there is high-level data from a Level I study showing no difference between ESI and anesthetic injections in patients with spinal stenosis. Friedly et al published a multisite blinded prospe","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"233-5"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34287708","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}

{"title":"Vertebral Osteomyelitis and Spinal Epidural Abscess: An Evidence-based Review.","authors":"Barrett S Boody,&nbsp;Tyler J Jenkins,&nbsp;Joseph Maslak,&nbsp;Wellington K Hsu,&nbsp;Alpesh A Patel","doi":"10.1097/BSD.0000000000000294","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000294","url":null,"abstract":"<p><p>Spinal infections have historically been associated with significant morbidity and mortality. Current treatment protocols have improved patient outcomes through prompt and accurate infection identification, medical treatment, and surgical interventions. Medical and surgical management, however, remains controversial because of a paucity of high-level evidence to guide decision making. Despite this, an awareness of presenting symptoms, pertinent risk factors, and common imaging findings are critical for treating spine infections. The purpose of this article is to review the recent literature and present the latest evidence-based recommendations for the most commonly encountered primary spinal infections: vertebral osteomyelitis and epidural abscess.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E316-27"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33267748","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}

{"title":"Spondylolisthesis, Sacro-Pelvic Morphology, and Orientation in Young Gymnasts.","authors":"Charles-William Toueg,&nbsp;Jean-Marc Mac-Thiong,&nbsp;Guy Grimard,&nbsp;Benoit Poitras,&nbsp;Stefan Parent,&nbsp;Hubert Labelle","doi":"10.1097/BSD.0b013e3182956d62","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182956d62","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional evaluation of sacro-pelvic morphology and orientation as well as spondylolisthesis prevalence in a cohort of young gymnasts.</p><p><strong>Objective: </strong>To evaluate the prevalence of spondylolisthesis in a cohort of gymnasts, as well as the associated demographic characteristics and sacro-pelvic morphology and orientation.</p><p><strong>Summary of background data: </strong>Numerous studies have shown that sagittal sacro-pelvic morphology and orientation is abnormal in spondylolisthesis. Sacro-pelvic morphology and orientation in gymnasts and their relationship with spondylolisthesis have never been analyzed.</p><p><strong>Methods: </strong>Radiologic evaluation of 92 gymnasts was performed to identify spondylolisthesis, and to measure pelvic incidence, pelvic tilt, sacral slope, and sacral table angle. In the presence of spondylolisthesis, the slip percentage was measured. Different demographic and training characteristics were evaluated. Radiographic parameters were compared with reference values published for asymptomatic children and adolescents, and for subjects with spondylolisthesis.</p><p><strong>Results: </strong>A 6.5% prevalence of spondylolisthesis was found in our cohort. The weekly training schedule was the only statistically significant different demographic characteristic between the 2 groups, at 20.6±5.4 versus 14.4±5.6 h/wk for subjects with and without spondylolisthesis, respectively. Pelvic incidence, pelvic tilt, sacral slope, and sacral table angle were 69±20, 15±13, 54±11, and 88±7 degrees in gymnasts with spondylolisthesis, and 53±11, 10±6, 43±9, and 94±6 degrees in gymnasts without spondylolisthesis, respectively. When compared with asymptomatic individuals, pelvic incidence and pelvic tilt were slightly superior in gymnasts without spondylolisthesis. Pelvic incidence, sacral slope, and sacral table angle were significantly different between gymnasts with and without spondylolisthesis.</p><p><strong>Conclusions: </strong>The prevalence of spondylolisthesis in young gymnasts was similar to that observed in the general population. Sagittal sacro-pelvic morphology and orientation was abnormal in gymnasts with spondylolisthesis. Sagittal sacro-pelvic morphology and orientation was also slightly different in gymnasts without spondylolisthesis when compared with the normal population. The present study supports an association between spondylolisthesis and abnormal sacro-pelvic orientation and morphology.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E358-64"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182956d62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31841484","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}

{"title":"Prospective Comparison Study Between the Fluoroscopy-guided and Navigation Coupled With O-arm-guided Pedicle Screw Placement in the Thoracic and Lumbosacral Spines.","authors":"Myung-Hoon Shin,&nbsp;Jung-Woo Hur,&nbsp;Kyeong-Sik Ryu,&nbsp;Chun-Kun Park","doi":"10.1097/BSD.0b013e31829047a7","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829047a7","url":null,"abstract":"<p><strong>Study design: </strong>This is a prospective randomized comparison study between the fluoroscopy-guided and navigation coupled with O-arm-guided pedicle screw placement in the thoracic and lumbosacral spines.</p><p><strong>Objective: </strong>The objective of the study was to evaluate the accuracy and clinical benefits of a navigation coupled with O-arm-guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method.</p><p><strong>Methods: </strong>Under fluoroscopy guidance, 138 pedicle screws were inserted from T9 to S1 in 20 patients, and 124 pedicle screws were inserted from T9 to S1 in 20 patients using the navigation. The position of the screws within the pedicle was assessed from grade 0 (no violation cortex) to grade 3 (>4 mm violation), and the location of the violated cortex was determined. Preparation time of each equipment setting, time for screwing, and the number of x-ray shots were evaluated.</p><p><strong>Results: </strong>The number of screws observed as grade 0 was 121 (87.7%) in the fluoroscopy-guided group and 114 (91.9%) in the navigation-guided group. The lateral cortex was most commonly involved in the fluoroscopy-guided group (6 cases, 35.3%), and the medial cortex was most common in the navigation-guided group (4 cases, 40%). The mean time required for preparation for screw placement was 3.7 minutes in the fluoroscopy-guided group and 14.2 minutes in the navigation-guided group. Average screwing time was 3.6 minutes in the fluoroscopy-guided group and 4.3 minutes in the navigation-guided group. The mean number of x-ray shots for each screw placement in the fluoroscopy-guided group was 6.5. Postoperatively, 2 patients with misplacement of a screw under fluoroscopy guidance presented ipsilateral leg paresthesia, possibly related to the screw position.</p><p><strong>Conclusions: </strong>The present prospective study reveals that the pedicle screw placement guided by the navigation coupled with O-arm system was more accurate and safer than that under fluoroscopy guidance.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E347-51"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829047a7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31337732","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}

{"title":"Surgical Management of Spinal Synovial Cysts: A Series of 23 Patients and Systematic Analysis of the Literature.","authors":"Steven Knafo,&nbsp;Philippe Page,&nbsp;Johan Pallud,&nbsp;François-Xavier Roux,&nbsp;Georges Abi-Lahoud","doi":"10.1097/BSD.0b013e31827179c8","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31827179c8","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort and review of the literature.</p><p><strong>Objective: </strong>To compare surgical strategies for the management of spinal synovial cysts.</p><p><strong>Summary of background data: </strong>The recent multiplication of retrospective series of patients with spinal synovial cysts has led to a reappraisal of their incidence and clinical significance. Although surgery is considered the treatment of choice, there is still no agreement over which surgical technique should be used.</p><p><strong>Methods: </strong>We retrospectively reviewed 23 consecutive patients undergoing surgery for a spinal synovial cyst in our department between 2004 and 2010. Surgical procedures were classified into the following 4 categories: cystectomy by an interlaminar approach, hemilaminectomy, laminectomy, or associated with instrumented spinal fusion. Clinical outcome, cyst recurrence, need for subsequent fusion, and perioperative complications were compared between these groups.</p><p><strong>Results: </strong>Of the patients included in the present cohort, 11 underwent cyst excision by an interlaminar approach, 8 had a hemilaminectomy, 2 had a laminectomy, and 2 underwent instrumented fusion. \"Excellent\" or \"good\" clinical outcome on the Macnab modified scale were achieved for 16 patients (69.6%), and there were 2 perioperative complications, 2 cyst recurrences, and 1 secondary fusion. Of the 519 patients reported in the literature, overall clinical outcome was either \"excellent\" or \"good\" for 83% of all patients. However, unfavorable outcome was more likely in patients treated with decompression alone (80/396) than decompression with fusion (10/123) (20.2% vs. 8.1%; P=0.003) and cyst recurrence (13/396 vs. 0/123; P=0.028). In contrast, the rate of perioperative complications was significantly higher in the fusion group (23/123) compared with decompression alone (11/396) (18.7% vs. 2.8%; P<0.0001).</p><p><strong>Conclusions: </strong>In patients with spinal synovial cyst, spinal fusion seems to decrease the risk of unfavorable clinical outcome and cyst recurrence and associated with a considerably higher rate of perioperative complications.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"211-7"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31827179c8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30890934","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}

{"title":"A Comparative Cohort Study of Lumbar Microdiscectomy in Obese and Nonobese Patients.","authors":"Bahram Fakouri,&nbsp;Matthew G Stovell,&nbsp;Richard Allom","doi":"10.1097/BSD.0b013e318290bf4a","DOIUrl":"https://doi.org/10.1097/BSD.0b013e318290bf4a","url":null,"abstract":"<p><strong>Study design: </strong>Prospective comparative cohort study.</p><p><strong>Objective: </strong>Investigate whether there is a difference in postoperative pain reduction, complication rate, and other markers of operative difficulty in obese and nonobese patients undergoing elective lumbar microdiscectomy by a single spinal surgeon.</p><p><strong>Summary of background data: </strong>Lumbar radiculopathy is a debilitating condition that affects obese and nonobese patients. There is reluctance among some surgeons to perform lumbar microdiscectomy in the obese population.</p><p><strong>Methods: </strong>Over 3 years a group of 34 obese patients were compared with 34 nonobese patients from the same period. Operative duration, blood loss, unintentional durotomies, infection rate, hospital stay, and pain reduction were compared.</p><p><strong>Results: </strong>Reduction in total pain (control, -82%; obese, -71%) and radicular leg pain (control, -98%; obese, -97%) were similar. The risk of superficial infections was greater in the obese group, but there was no difference in rate of serious complication in our small series. Operative duration was much longer in the obese group (control, 28 min; obese, 70 min), as was total hospital stay.</p><p><strong>Conclusions: </strong>We found good postoperative pain relief in both groups. There was no difference in radicular leg pain between obese and nonobese patients but total pain due to lumbago was greater preoperatively and postoperatively in the obese group making their total pain greater. There was no evidence of higher serious complication rate that would preclude offering operative lumbar microdiscectomy to obese patients due to their obesity alone. However, operative duration was significantly longer in obese patients and should be considered accordingly.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E352-7"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e318290bf4a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31337733","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}

{"title":"Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Junyoung Ahn,&nbsp;Ehsan Tabaraee,&nbsp;Kern Singh","doi":"10.1097/BSD.0000000000000289","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000289","url":null,"abstract":"<p><p>Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is performed via tubular dilators thereby preserving the integrity of the paraspinal musculature. The decreased soft tissue disruption in the MIS technique has been associated with significantly decreased blood loss, shorter length of hospitalization, and an expedited return to work while maintaining comparable arthrodesis rates when compared with the open technique particularly in the setting of spondylolisthesis (isthmic and degenerative), recurrent symptomatic disk herniation, spinal stenosis, pseudoarthrosis, iatrogenic instability, and spinal trauma. The purpose of this article and the accompanying video wass to demonstrate the techniques for a primary, single-level MIS TLIF.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"222-5"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33393972","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}

{"title":"Comparison of Clinical Outcomes and Radiographic Measurements in 4 Different Treatment Modalities for Osteoporotic Compression Fractures: Retrospective Analysis.","authors":"Gerard Wen Wei Ee,&nbsp;Jiang Lei,&nbsp;Chang Ming Guo,&nbsp;William Yeo,&nbsp;Seang Beng Tan,&nbsp;Phak Boon Benjamin Tow,&nbsp;Li Tat John Chen,&nbsp;Wai-Mun Yue","doi":"10.1097/BSD.0b013e31828f940c","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828f940c","url":null,"abstract":"<p><strong>Study design: </strong>We conducted a retrospective analysis of a prospectively collected database in a tertiary hospital over 10 years.</p><p><strong>Objective: </strong>Treatment for vertebral compression fractures remains an area of controversy with respect to timing and type of surgical management. We analyzed the clinical outcomes and radiographic measurements of 4 different modalities of treatment for these fractures.</p><p><strong>Summary of background data: </strong>From 2001 to 2011, we analyzed a total of 363 patients after failure of 30 days of conservative management. These patients were then further managed either conservatively or with vertebroplasty, balloon kyphoplasty, or sky bone expander. Outcomes were assessed by using self-report measures: Visual Analog Score; functional measures: Oswestry Disability Index and Short-Form 36; and physiological measures: preoperative and postoperative radiographs.</p><p><strong>Methods: </strong>The outcome measures were assessed for 6 months for those treated conservatively and up till 2 years for those treated surgically. Radiographic measurements of the spine were correlated with the clinical outcomes.</p><p><strong>Results: </strong>A total of 62 patients (12.1%) were treated conservatively, 148 (40.8%) with vertebroplasty, 97 (26.7%) with balloon kyphoplasty, and 56 (15.4%) with sky bone expander. We found significant improvements in Visual Analog Score, Oswestry Disability Index, and Short-Form-36 scores for all groups after 1-month follow-up (P<0.05), with the surgical groups demonstrating a greater improvement in pain scores after the first postoperative day (P<0.0001) when compared with the conservative group. The improvements in outcomes in those treated surgically were sustained for up to 2 years with no significant difference (P>0.05) among the surgical groups. We also found significant improvement (P<0.005) in anterior vertebral and kyphotic wedge angle after surgical intervention.</p><p><strong>Conclusions: </strong>We have shown that early surgical intervention allows for quicker pain relief compared with conservative treatment, with similar improvements in anterior vertebral height and kyphotic wedge angle between all 3 groups of surgical management.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E328-35"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828f940c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31339194","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}

{"title":"Complications and Unfavorable Clinical Outcomes in Obese and Overweight Patients Treated for Adult Lumbar or Thoracolumbar Scoliosis With Combined Anterior/Posterior Surgery.","authors":"Mitsuru Yagi,&nbsp;Ravi Patel,&nbsp;Oheneba Boachie-Adjei","doi":"10.1097/BSD.0b013e3182999526","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182999526","url":null,"abstract":"<p><strong>Background context: </strong>Combined anterior/posterior (A/P) spinal fusion with instrumentation has been used for many years in the treatment of adult thoracolumbar and lumbar (TL/L) scoliosis. However, the risk factors for complications and poor clinical outcomes with this procedure are not well known.</p><p><strong>Purpose: </strong>To assess the risk factors for poor clinical outcomes in a series of adult lumbar or scoliosis patients undergoing combined A/P-instrumented spinal fusion.</p><p><strong>Study design: </strong>This study was a retrospective case series of surgically treated adult lumbar or thoracolumbar scoliosis patients.</p><p><strong>Patient sample: </strong>From 1998 to 2006, 57 patients with diagnoses of adult idiopathic scoliosis or degenerative TL/L scoliosis underwent combined A/P spinal instrumentation and fusion at 1 institution, performed by 1 senior author.</p><p><strong>Outcome measurements: </strong>The preoperative and postoperative outcome measurements included self-report measurements, physiological measurements, and functional measurements.</p><p><strong>Materials and methods: </strong>A retrospective review of this patient group was performed to evaluate patient satisfaction, functional outcomes, pain, curve progression, and complications. Radiographic measurements included coronal balance, sagittal vertical axis, Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence preoperatively, immediately postoperatively, and during follow-up. In terms of risk factors, bone mineral density, body mass index, age, kyphosis, and fusion to the sacrum were reviewed. Postoperative Scoliosis Research Society Patient Questionnaire outcome scores, Oswestry Disability Index (ODI), and anterior surgical site pain (ASSP) were also evaluated. Means were compared with the Student t test and the χ test. Logistic regression analyses were used to predict the probabilities and the odds ratios (ORs) of the risk factors for poor clinical outcomes. A P-value of <0.05 with a confidence interval of 95% was considered significant.</p><p><strong>Results: </strong>Fifty patients had adult idiopathic scoliosis, and 7 patients had degenerative scoliosis. The average age at surgery was 53.8 years (34-74 y), and the average follow-up was 4.8 years (2-11 y). Coronal correction for thoracic, thoracolumbar, and lumbosacral curves improved significantly. The degree of sagittal curve and coronal and sagittal balance were not significantly changed after surgery or at the final follow-up. ODI, the pain intensity domain of the ODI, and ASSP were significantly worse in obese and overweight patients, whereas OR time, estimated blood loss, and number of fused vertebrae were not different in the entire group (P=0.03 for ODI, P=0.002 for pain domain of ODI, and P=0.003 for ASSP). Logistic regression analyses for the risk factors of poor clinical outcomes indicated obesity and overweight as risk factors for poor clinical outcomes (OR=6.25 f","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E368-76"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182999526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31542875","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}