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1.
Alisson R. Teles Don Daniel Ocay Abdulaziz Bin Shebreen Andrew Tice Neil Saran Jean A. Ouellet Catherine E. Ferland 《The spine journal》2019,19(4):677-686
BACKGROUND CONTEXT
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.PURPOSE
To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.STUDY DESIGN
Cross-sectional study.PATIENT SAMPLE
Ninety-four patients diagnosed with AIS and chronic back pain.OUTCOME MEASURES
Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.METHODS
Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.RESULTS
Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048).CONCLUSIONS
Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome. 相似文献2.
BACKGROUND
The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.PURPOSE
The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.STUDY DESIGN/SETTING
Double blinded randomized controlled clinical trial.PATIENT SAMPLE
A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.OUTCOME MEASUREMENT
Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.METHOD
A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.RESULTS
VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.CONCLUSIONS
Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure. 相似文献3.
Jaime Ruiz-Tovar Alejandro Garcia Carlos Ferrigni Juan Gonzalez Camilo Castellon Manuel Duran 《Surgery for obesity and related diseases》2019,15(2):228-235
Background
The essence of enhanced recovery after surgery (ERAS) program is the multimodal approach, and many authors have demonstrated safety and feasibility in fast-track bariatric surgery.Objectives
The aim of this study was to evaluate the postoperative pain after the implementation of an ERAS protocol in Roux-en-Y gastric bypass and to compare it with the application of a standard care protocol.Setting
University Hospital Rey Juan Carlos, Madrid, Spain.Methods
A prospective randomized clinical trial of all the patients undergoing Roux-en-Y gastric bypass was performed. Patients were randomized into the following 2 groups: those patients after an ERAS program and those patients after a standard care protocol. Postoperative pain, nausea or vomiting, morbidity, mortality, hospital stay, and analytic acute phase reactants 24 hours after surgery were evaluated.Results
One hundred eighty patients were included in the study, 90 in each group. Postoperative pain (16 versus 37 mm; P < .001), nausea or vomiting (8.9% versus 2.2%; P?=?.0498), and hospital stay (1.7 versus 2.8 d; P < .001) were significantly lower in the ERAS group. There were no significant differences in complications, mortality, and readmission rates. White blood cell count, serum fibrinogen, and C reactive protein levels were significantly lower in the ERAS group 24 hours after surgery.Conclusion
The implementation of an ERAS protocol was associated with lower postoperative pain, reduced incidence of postoperative nausea or vomiting, lower levels of acute phase reactants, and earlier hospital discharge. Complications, reinterventions, mortality, and readmission rates were similar to that obtained after a standard care protocol. 相似文献4.
P. Endler P. Ekman H. Ljungqvist T.B. Brismar P. Gerdhem H. Möller 《The spine journal》2019,19(3):501-508
BACKGROUND CONTEXT
Data on the long-term outcome after fusion for isthmic spondylolisthesis are scarce.PURPOSE
To study patient-reported outcomes and adjacent segment degeneration (ASD) after fusion for isthmic spondylolisthesis and to compare patient-reported outcomes with a control group.STUDY DESIGN/SETTING
A prospective study including a cross-sectional control group.PATIENT SAMPLE
Patients with isthmic spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) (n=86) or posterolateral fusion (PLF) (n=77). Patient-reported outcome data were available for 73 patients in the PLIF group and 71 in the PLF group at a mean of 11 (range 5–16) years after baseline. Seventy-seven patients in the PLIF group and 54 in the PLF group had radiographs at a mean of 14 (range 9–19) years after baseline. One hundred thirty-six randomly selected persons from the population served as controls for the patient-reported outcomes.OUTCOME MEASURES
Patient-reported outcomes include the following: global outcome, Oswestry Disability Index, Disability Rating Index, and Short Form 36. The ASD was determined from radiographs using the University of California Los Angeles (UCLA) grading scale.METHODS
: The chi-square test or analysis of covariance (ANCOVA) was used for group comparisons. The ANCOVA was adjusted for follow-up time, smoking, Meyerding slippage grade, teetotaler (yes/no) and, if available, the baseline level of the dependent variable.RESULTS
There were no significant patient-reported outcome differences between the PLIF group and the PLF group. The prevalence of ASD was 42% (32/77) in the PLIF group and 26% (14/54) in the PLF group (p=.98). The patient-reported outcome data indicated lower physical function and more pain in individuals with surgically treated isthmic spondylolisthesis compared to the controls.CONCLUSIONS
PLIF and PLF groups had similar long-term patient-reported and radiological outcomes. Individuals with isthmic spondylolisthesis have lower physical function and more pain several years after surgery when compared to the general population. 相似文献5.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468
BACKGROUND CONTEXT
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.PURPOSE
To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.STUDY DESIGN/SETTING
Cross-sectional diagnostic study.PATIENT SAMPLE
Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP and TSE high bandwidth sequences).OUTCOME MEASURES
Sensitivity and specificity in detection of screw loosening for each imaging modality.METHODS
Screw torque force was measured intraoperatively and compared with preoperative screw loosening signs such as peri-screw edema in MRI and peri-screw osteolysis in CT and radiographs. A torque force of less than 60 Ncm was used to define a screw as loosened.RESULTS
Sensitivity and specificity in detection of screw loosening was 43.9% and 92.1% for MRI, 64.8% and 96.7% for CT, and 54.2% and 83.5% for standard radiographs, respectively.CONCLUSIONS
Despite improvement of MRI with metal artifact reduction MRI technique, CT remains the modality of choice. Even so, CT fails to detect all loosened pedicle screws. 相似文献6.
BACKGROUND CONTEXT
Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.PURPOSE
This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis.STUDY DESIGN/SETTING
A retrospective comparative study.PATIENT SAMPLE
PVO patients with osteoporosis.OUTCOME MEASURES
Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.METHODS
PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest.RESULTS
A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p?=?.014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p?=?.001 for model 1 and p?=?.002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups.CONCLUSIONS
Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery. 相似文献7.
Imad S Nahle Hubert Labelle Stefan Parent Julie Joncas Jean-Marc Mac-Thiong 《The spine journal》2019,19(4):670-676
BACKGOUND CONTEXT
Abnormal proximal femoral angle (PFA) was recently found to be associated with deteriorating sagittal balance and quality of life (QoL) in high-grade spondylolisthesis (HGS). However, the influence of PFA on the QoL of patients undergoing surgery remains unknown.PURPOSE
This study compares the pre- and postoperative measurements of sagittal balance including PFA in patients with lumbosacral HGS after surgery. It also determines if PFA is a radiographic parameter that is associated with QoL in patients undergoing surgery.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Thirty-three patients (mean age 15.6 ± 3.0 years) operated for L5-S1 HGS between July 2002 and April 2015. Thirteen had in situ fusion and 20 had reduction to a low-grade slip.OUTCOME MEASURES
The outcome measures included PFA and QoL scores measured from the Scoliosis Research Society SRS-30 QoL questionnaire.METHODS
The minimum follow-up was 2 years. PFA and QoL were compared pre- and postoperatively. Statistical analysis used nonparametric Mann-Whitney and Wilcoxon Signed Rank tests, Chi-square tests to compare proportions, and bivariate correlations with Spearman's coefficients.RESULTS
A decreasing PFA correlated with less pain (r = ?0.56, p?=?.010), improved function (r = ?0.51, p?=?.022) and better self-image (r = ?0.46, p?=?.044) postreduction. Reduction decreased PFA by 5.1° (p?=?.002), whereas in situ fusion did not alter PFA significantly. Patients with normal preoperative PFA had similar postoperative QoL regardless of the type of surgery, except for self-image, which improved further with reduction (3.73 ± 0.49 to 4.26 ± 0.58, p?=?.015). Patients with abnormal preoperative PFA tended to have a higher QoL in all domains after reduction.CONCLUSION
Decreasing PFA correlates with less pain, better function and self-image. Reduction of HGS decreases PFA. Reduction also relates to a better postoperative QoL when the preoperative PFA is abnormal. When the preoperative PFA is normal, in situ fusion is equivalent to reduction except for self-image, which is better improved after reduction. 相似文献8.
Carlo Ammendolia Y. Raja Rampersaud Danielle Southerst Aksa Ahmed Michael Schneider Gillian Hawker Claire Bombardier Pierre Côté 《The spine journal》2019,19(3):386-394
BACKGROUND CONTEXT
Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking.PURPOSE
The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS.STUDY DESIGN
This was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLE
We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURES
The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals.METHODS
Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years).RESULTS
Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was ?74 m (95% CI: ?282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5–1.3, p=.43).CONCLUSIONS
A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. 相似文献9.
Nagy Mekhail Diana Mehanny Sherif Armanyous Youssef Saweris Shrif Costandi 《The spine journal》2019,19(3):476-486
BACKGROUND CONTEXT
Chronic pain and obesity are both on the rise. Spinal cord stimulation has gained increasing popularity in the pain management field for the treatment of spine-related chronic pain, however to-date, the correlation between the spinal cord stimulator effectiveness and increasing body mass index (BMI) has not been fully established.PURPOSE
We aimed to investigate the correlation between patients’ BMI and the percentage of pain relief as well as opioid utilization in chronic spine-related pain patients treated with spinal cord stimulation.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Patients with chronic spine-related pain who were treated with a spinal cord stimulator.OUTCOME MEASURES
Eleven-point numeric rating scale for pain and opioid utilization.METHODS
Following Institutional Review Board approval, data from all eligible subjects who had undergone successful spinal cord stimulation (SCS)-trial defined as ≥50% decrease in pain followed by SCS implant were collected and statistically analyzed. Patients were divided into four groups according to BMI. Self-reported pain scores on the 11-point numerical rating scale were collected at baseline, 6 months and 12 months post SCS-implant visits. Opioid utilization, if any, was collected at baseline and 12 months post-SCS implant.RESULTS
In all, 181 patients were included. Thirty-three were under and/or normal weight (≤24.9 kg/m2), 72 overweight (25.0–29.9 kg/m2), 63 obese (30.0–39.9 kg/m2), and 13 morbidly obese (≥40.0 kg/m2). The estimated coefficients from multivariable linear regression analysis were ?1.91% (95% CI: ?2.82% to ?0.991%) and ?1.48% (95% CI: ?2.30% to ?0.660%) reduction in pain improvement per unit increase of BMI for 6 months and 12 months scores, respectively. The estimated coefficient of disability status was ?15.3% (95% CI: ?22.1% to ?8.48%). The estimated coefficient for 12 month opioid equivalence was ?0.08% (95% CI: ?0.14 to ?0.021), per` 1 mg unit increase of morphine opioid equivalency. The data showed a statistically significant negative association between increasing BMI and SCS effectiveness at 6 and 12 months post-SCS therapy with a 2% reduction in efficacy for every unit increase of BMI after adjusting for confounding factors and a 20% better response in underweight and/or normal patients over the morbidly obese individuals which was not related to baseline pain score level. The significant difference in pain scores at 6 months (p = .0003) and 12 months (p = .04) post-SCS implant between obese and nonobese patients was not attributable to differences in baseline pain scores. There was no significant change in opioid utilization between baseline and 12 months post-SCS therapy.CONCLUSION
A negative association between SCS effectiveness and increasing BMI was found, whereas, no significant difference was noted amongst the various BMI cohorts and the daily opioid consumption. 相似文献10.
Selective blocking laminoplasty in cervical laminectomy and fusion to prevent postoperative C5 palsy
BACKGROUND CONTEXT
Cervical laminectomy and fusion (CLF) is a common surgical option for multilevel cord compression. Postoperative C5 palsy occurrence after CLF has been a vexing problem for spine physicians. The posterior shift of the cord following laminectomy has been implicated as a major factor for postoperative C5 palsy, but attempts by spine surgeons to mitigate excessive shift while providing sufficient decompression have not been well reported.PURPOSE
To compare the incidence of postoperative C5 palsy after performing selective blocking laminoplasty concurrently with CLF to those of conventional CLF.STUDY DESIGN
A retrospective comparative study of prospectively collected data.PATIENT SAMPLE
Of 116 cervical myelopathy patients with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, and multilevel disc herniation, 93 patients (69 in group A [CLF group] and 24 in group B [selective blocking laminoplasty with CLF, CLF-S group]) were included in the study.OUTCOME MEASURES
The primary outcome measure was the occurrence of postoperative C5 palsy. Secondary end points included (1) clinical outcomes based on pain intensity, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, (2) radiologic outcomes including cervical alignment and fusion rate at 1 year and hardware complications, and (3) perioperative data (hospital stay, blood loss, and operative times).METHODS
We compared the occurrence of postoperative C5 palsy, as well as clinical, radiologic, and surgical outcomes, between the two groups at 1-year follow-up.RESULTS
The patients in both groups were statistically similar between the groups with respect to demographic characteristics such as age, sex, smoking status, body mass index, preoperative pathology, surgical segments, and the degree of the cervical lordosis. Postoperative C5 palsy developed in 9 of 61 patients (14%) in group A and in 0 of 24 patients (0%) in group B (CLF-S group) (p=.03). Postoperative neck pain, NDI, and JOA improvement were not significantly different between the two groups (p=.93, 0.90, and 0.79, respectively). Perioperative data did not differ significantly between the two groups.CONCLUSIONS
This study showed that performing selective blocking laminoplasty might lead to reducing the incidence of postoperative C5 palsy in CLF surgery. 相似文献11.
Ragnhild B. Wijma Marloes Emous Merel van den Broek Anke Laskewitz Anneke C. Muller Kobold André P. van Beek 《Surgery for obesity and related diseases》2019,15(1):73-81
Background
Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).Objective
We performed a mixed-meal tolerance test in patients after RYGB to address the prevalence of early dumping and to gain further insight into its pathophysiology.Setting
The study was conducted in a regional hospital in the northern part of the Netherlands.Methods
From a random sample of patients who underwent primary RYGB between 2008 and 2011, 46 patients completed the mixed-meal tolerance test. The dumping severity score for early dumping was assessed every 30 minutes. A sum score at 30 or 60 minutes of ≥5 and an incremental score of ≥3 points were defined as indicating a high suspicion of early dumping. Blood samples were collected at baseline, every 10 minutes during the first half hour, and at 60 minutes after the start.Results
The prevalence of a high suspicion of early dumping was 26%. No differences were seen for absolute hematocrit value, inactive glucagon-like peptide-1, and vasoactive intestinal peptide between patients with or without early dumping. Patients at high suspicion of early dumping had higher levels of active glucagon-like peptide-1 and peptide YY.Conclusion
The prevalence of complaints at high suspicion of early dumping in a random population of patients after RYGB is 26% in response to a mixed-meal tolerance test. Postprandial increases in both glucagon-like peptide-1 and peptide YY are associated with symptoms of early dumping, suggesting gut L-cell overactivity in this syndrome. 相似文献12.
BACKGROUND CONTEXT
Fungal spinal epidural abscess (FSEA) is a rare entity with high morbidity and mortality. Reports describing the clinical features, diagnosis, treatment, and outcomes of FSEA are scarce in the literature.PURPOSE
This study aimed to describe the clinical features, diagnosis, treatment, and outcomes of FSEA.STUDY DESIGN
This study is designed as a retrospective clinical case series.PATIENT SAMPLE
A continuous series of patients with the diagnosis of FSEA who presented at our institution from 1993 to 2016.METHODS
We reviewed the electronic medical records of patients with SEA who were treated within our hospital system from 1993 to 2016. We only included SEA cases that were due to fungi. We also reviewed FSEA cases in the English language literature from 1952 to 2017 to analyze the features of FSEA.RESULTS
From a database of 1,053 SEA patients, we identified 9 patients with FSEA. Aspergillus fumigatus was isolated from 2 (22%) patients, and Candida species were isolated from 7 (78%). Focal spine pain, neurologic deficit, and fever were demonstrated in 89%, 50%, and 44% of FSEA cases, respectively. Five of nine cases involved the thoracic spine, and eight were located anterior to the thecal sac. Three cases had fungemia, six had long symptom duration (>2 weeks) prior to presentation, seven had concurrent immunosuppression, and eight had vertebral osteomyelitis. Additionally, one case had residual motor deficit at last follow-up, one had S1 sensory radicular symptoms, two suffered recurrent FSEA, two died within hospitalization, and two died within 90 days after discharge.CONCLUSIONS
In summary, the classic diagnostic triad (focal spine pain, neurologic deficit, and fever) is not of great clinical utility for FSEA. Biopsy, intraoperative tissue culture, and blood culture can be used to diagnose FSEA. The most common pathogens of FSEA are Aspergillus and Candida species. Therefore, empiric treatment for FSEA should cover these species while definitive identification is pending. FSEA is found in patients with poor baseline health status, which is the essential reason for its high mortality. 相似文献13.
14.
Eva Jacobs Sander M.J. van Kuijk Johannes M.R. Merk Mieke Vandewall-Peeters Liesbeth M.C. Jütten-Brouwer Lodewijk W. van Rhijn Paul C. Willems 《The spine journal》2019,19(4):655-661
BACKGROUND CONTEXT
Degenerative lumbar scoliosis (DLS) is an increasingly common spinal disorder of which current management is characterized by a substantial variety in treatment advice. To improve evidence-based clinical decision-making and increase uniformity and transparency of care, the Scoliosis Research Society established appropriateness criteria for surgery for DLS. In these criteria, however, the patient perspective was not formally incorporated. Since patient perspective is an increasingly important consideration in informed decision-making, embedding patient-reported outcome measures (PROMs) in the appropriateness criteria would allow for an objective and transparent patient-centered approach.PURPOSE
To evaluate the extent that patient perspective is integrated into the appropriateness criteria of surgery for DLS.STUDY DESIGN
Single center, retrospective, cohort study.PATIENT SAMPLE
150 patients with symptomatic degenerative lumbar scoliosis.Outcome Measures
The association between appropriateness for surgery and various PROMs [Visual Analogue Scale for pain, Short Form 36 (SF-36), Pain Catastrophizing Scale (PCS), Hospital Anxiety Depression Scale (HADS), and Oswestry Disability Index (ODI)].METHODS
Medical records of all patients with symptomatic DLS were reviewed and scored according to the appropriateness criteria. To assess the association between the appropriateness criteria and the validated PROMs, analysis of variance was used to test for differences in PROMS for each of the three categories resulting from the appropriateness criteria. To assess how well PROMs can discriminate between appropriate and inappropriate, we used a logistic regression analysis. Discriminative ability was subsequently determined by computing the area under the curve (AUC), resulting from the logistic regression analysis. Spearman rank analysis was used to establish a correlation pattern between the PROMs used and the appropriateness criteria.RESULTS
There was a significant association between the appropriateness of surgery and the PROMs. The discriminative ability for appropriateness of surgery for PROMs as a group was strong (AUC of 0.83). However, when considered in isolation, the predictive power of any individual PROMs was poor. The different categories of the appropriateness criteria significantly coincided with the PROMs used.CONCLUSION
There is a statistically significant association between the appropriateness criteria of surgery for DLS and PROMs. Implementation of PROMs into the appropriateness criteria may lead to more transparent, quantifiable and uniform clinical decision making for DLS. 相似文献15.
Luis F. Zorrilla-Nunez Anthony Campbell Giulio Giambartolomei Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(1):43-49
Background
Bariatric surgery has proven to be the most durable treatment for obesity, and it also provides improvement of obesity's associated co-morbidities. Although several mechanisms for its metabolic effects have been studied, the implications of the surgically constructed anatomy on its functioning physiology have not been elucidated. This leaves some uncertainty regarding the recommended limb lengths in Roux-en-Y gastric bypass. The alimentary limb length and function has been studied extensively, but few have studied the influences of the biliopancreatic limb length.Objective
To present a systematic review of the literature comparing variations in length of BP limb and results in order to determine BP limb length influence.Setting
Academic Hospital, United States.Methods
We present a systematic review of all the articles comparing variations of the biliopancreatic limb length and their results.Results
Thirteen articles were identified and analyzed. Most of the articles are prospective studies. Weight loss was superior in longer limbs.Conclusion
Based on our review of the subject, we can conclude that the release of enterohormones in response to a food load in the distal small bowel seems to play an important role in the remission of co-morbidities. Hence, the length of the biliopancreatic limb might affect this process. 相似文献16.
Kevin T. Lynch J. Hunter Mehaffey Robert B. Hawkins Taryn E. Hassinger Peter T. Hallowell Jennifer L. Kirby 《Surgery for obesity and related diseases》2019,15(2):279-285
Background
Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.Objectives
To assess the association between bariatric surgery and AF prevention.Setting
University Hospital, United States.Methods
All patients who underwent bariatric surgery at a single institution from 1985–2015 (n?=?3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n?=?45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups.Results
After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P?=?0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P?=?0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs ?3.8%, P<0.001).Conclusion
The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. 相似文献17.
Shinichi Ishihara Nobuyuki Fujita Koichiro Azuma Takehiro Michikawa Mitsuru Yagi Takashi Tsuji Michiyo Takayama Hideo Matsumoto Masaya Nakamura Morio Matsumoto Kota Watanabe 《The spine journal》2019,19(3):493-500
BACKGROUND CONTEXT
Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted.PURPOSE
To elucidate potential association between SEL and metabolic syndrome.STUDY DESIGN
An observational study used data of a medical checkup.PATIENT SAMPLE
We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study.OUTCOME MEASURES
The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated.METHODS
The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated.RESULTS
The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL.CONCLUSION
This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome. 相似文献18.
Shingo Morishita Toshitaka Yoshii Atsushi Okawa Kiyohide Fushimi Takeo Fujiwara 《The spine journal》2019,19(4):610-616
BACKGROUND CONTEXT
Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.PURPOSE
To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database.STUDY DESIGN
A retrospective cohort study with propensity score matching analysis.PATIENT SAMPLE
Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed.OUTCOME MEASURES
The occurrence of postoperative complications during hospitalization.METHODS
We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis.RESULTS
One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups.CONCLUSION
The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group. 相似文献19.
Ivy N. Haskins Lisbi Rivas Tammy Ju Ashlyn E. Whitlock Richard L. Amdur Anton N. Sidawy Paul P. Lin Khashayar Vaziri 《Surgery for obesity and related diseases》2019,15(1):109-115
Background
Venous thromboembolism, including pulmonary embolism (PE) and deep venous thrombosis, is a leading cause of morbidity and mortality after bariatric surgery. Inferior vena cava filters (IVCFs) have been used as a method to reduce the incidence of clinically significant PEs after bariatric surgery.Objectives
To compare the incidence of postoperative PEs in patients with IVCFs with those in patients without IVCFs at the time of bariatric surgery.Setting
American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.Methods
All patients undergoing laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy from 2015 to 2016 were identified within the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients with an IVCF present at the time of surgery were compared with those patients without an IVCF present at the time of surgery with respect to preoperative patient variables, operative variables, incidence of 30-day PE, deep venous thrombosis, and additional 30-day morbidity and mortality.Results
A total of 286,704 patients met the inclusion criteria; 2512 (.9%) patients had an IVCF present at the time of surgical intervention, of which 1747 (69.5%) were placed within 30 days of bariatric surgery. Patients with an IVCF were higher-risk patients as determined by previously established risk factors for venous thromboembolism events. When a subgroup matched analysis using variables associated with the risk of venous thromboembolism events was performed looking at higher-risk patients only, there was no statistically significant difference in the incidence of PE based on the presence of an IVCF.Conclusion
IVCFs are being selectively placed in higher-risk patients. Despite their selective use, IVCFs do not appear to have a protective benefit with respect to the incidence of postoperative PE events. 相似文献20.
Wethit Dumronggittigule Elizabeth A. Marcus Bernard J. DuBray Robert S. Venick Erik Dutson Douglas G. Farmer 《Surgery for obesity and related diseases》2019,15(1):98-108
