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Day: February 12, 2016

Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy.

By wp_zaman

Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy.

J Neurosurg Spine. 2011 Feb;14(2):261-7

Authors: Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, McGirt MJ

Lumbar discectomy is the most common surgical procedure performed in the US for patients experiencing back and leg pain from herniated lumbar discs. However, not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor clinical outcomes. The goal of this study was therefore to determine the role that preoperative depression and somatic anxiety have on long-term back and leg pain, disability, and quality of life (QOL) for patients undergoing single-level lumbar discectomy.

PMID: 21214315 [PubMed – indexed for MEDLINE]

[Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation].

By wp_zaman
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[Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation].

Zhonghua Wai Ke Za Zhi. 2012 Apr;50(4):338-41

Authors: Lü CL, Song YM, Liu H, Liu LM, Gong Q, Li T, Zeng JC, Kong QQ, Pei FX, Tu CQ, Duan H

Abstract
OBJECTIVE: To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.
METHODS: In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements.
RESULTS: All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Postoperative immediate intervertebral height (2.4 ± 0.2) cm, preoperative intervertebral height (1.9 ± 0.1) cm, comparisons of the two groups was statistically significant (q = 2.48, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant (P > 0.05). Preoperative Cobb angle was 9.8° ± 1.2°, postoperative immediate Cobb angle was 16.6° ± 1.2°, comparisons of the two groups was statistically significant (q = 14.25, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group Cobb angle was not statistically significant (P > 0.05).
CONCLUSIONS: n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior lower cervical spine fracture and dislocation operation, but further follow-up study is still required to evaluate the long-term effects.

PMID: 22800787 [PubMed – indexed for MEDLINE]

Assessment of adjacent-segment mobility after cervical disc replacement versus fusion: RCT with 1 year’s results.

By wp_zaman

Assessment of adjacent-segment mobility after cervical disc replacement versus fusion: RCT with 1 year’s results.

Eur Spine J. 2011 Jun;20(6):934-41

Authors: Nabhan A, Ishak B, Steudel WI, Ramadhan S, Steimer O

Disc prostheses have been designed to restore and maintain cervical segmental motion and reduce the accelerated degeneration of the adjacent level. There is no knowledge about the reaction of the neighboured asymptomatic segments after implantation of prostheses or fusion. The effects of these procedures to segmental movement of the uninvolved vertebrae have not been subjected to studies so far. The objective of this study was to compare the segmental motion following cervical disc replacement versus fusion and the correlation to the clinical outcome. Another aim was to compare the segmental motion of the asymptomatic segments above the treated ones and to compare both with Roentgen stereometric analysis (RSA) including the asymptomatic segments. 20 patients with one-level cervical radiculopathy scheduled for surgery were randomized to arthroplasty (10 patients, study group) or anterior cervical discectomy and fusion (10 patients, control group). Clinical results were evaluated using Visual Analogue Scale and Neck Disability Index. RSA was performed immediately postoperative, after 6 and 12 months. The adjacent segment showed a significantly higher segmental motion in all three-dimensional axes in comparison to the segment treated with prostheses (P < 0.05). In the fusion group the segmental motion of the adjacent segment was significantly higher in all three-dimensional axes (P < 0.05) at each examination time. When the adjacent level of both groups is compared, the fusion group could show a higher segmental motion in all three-dimensional axes, but without significant difference (P > 0.05) 1 year after surgery. Regarding the clinical results, there was no significant difference in pain relief between both groups (P > 0.05). In conclusion, the adjacent segment could show a higher segmental motion, when compared with the segment either treated with prostheses or fusion. There was no significant difference in segmental motion adjacent to prosthesis or fusion. Clinical results did also show no significant difference in pain relief between both groups.

PMID: 21221666 [PubMed – in process]

Acute Changes in Mentation in a Patient with Hepatic Cirrhosis Treated with High Doses of Dexamethasone.

By Kamruz Zaman
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Acute Changes in Mentation in a Patient with Hepatic Cirrhosis Treated with High Doses of Dexamethasone.

Cureus. 2017 Sep 10;9(9):e1675

Authors: Dabul L, Droney A, Oms J, Sanchez-Gonzalez MA

Abstract
Despite the anti-inflammatory benefits of steroids in the management of multiple medical conditions, they are associated with undesired metabolic and psychiatric side effects. We present a case of a 57-year-old Hispanic man with hepatic cirrhosis due to hepatitis C and no past medical history of psychiatric illnesses who became delirious after treatment with high doses of intravenous Dexamethasone. The patient presented to Larkin Community Hospital, USA with complaints of lower back pain requiring treatment with steroids for severe lumbar central canal stenosis. After three days of treatment, the patient became disoriented to time and place, grossly psychotic with auditory hallucinations and disorganized behavior, manic, aggressive, combative, restless, hard to redirect, and unable to follow commands. He met the criteria for a diagnosis of substance-induced psychotic disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM) V. Furthermore, the patient had worsening hepatic profile, a high ammonia level of 125 umol/L, and clinical findings consistent with West Haven classification grade 2 encephalopathy. Head computed tomography (CT) scan was normal. He was treated with discontinuation of steroids, lactulose, and Haloperidol returning to baseline mental status after 48 hours. The patient’s hospitalization was complicated with a prolonged hospital stay after lumbar surgery. This case illustrates that treatment with high doses of Dexamethasone in a patient with hepatic cirrhosis can cause acute changes in mental status by (i) inducing delirium, and (ii) precipitating hepatic encephalopathy.

PMID: 29152432 [PubMed]

Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension and fulcrum bending film.

By wp_zaman

Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension and fulcrum bending film.

Spine (Phila Pa 1976). 2011 Jan 7;

Authors: Chen ZQ, Wang CF, Bai YS, Zhu XD, Yang CW, Xie Y, Li M

ABSTRACT: Study Design. A prospective study.Objective. To validate the effectiveness of push-traction film (PTF) in assessment of curve flexibility in adolescent idiopathic scoliosis (AIS).Summary of Background Data. There is no agreement amongst surgeons about the most advantageous method in flexibility evaluation of scoliosis. As all methods available provide the orthopedic force from one direction and use a single torque, it is difficult for them to achieve the postoperative correction, nor could they meet the needs for different types of curves.Methods. Precisely controlled bidirectional (push and traction) orthopedic forces were applied for curve flexibility evaluation in 31 consecutive AIS patients. The correction rate(CR) of post-operation (Post-op), supine side -bending (SB), suspension and fulcrum bending (FB) radiographs were compared with PTF in instrumented main thoracic (MT) and thorocolumbar/lumbar (TL/L) curves. Correlation and linear regression analyses were also been done to find the best predictor among the four methods.Results. In MT group, CR of PTF was significantly higher than that of SB (P = 0.010) and suspension (P = 0.000 ) but not significantly different from that of FB (P = 0.335). In ML/L group, CR of PTF was significantly higher than that of suspension (P = 0.000), but not significantly different from that of SB (P = 0.681) and FB (P = 0.382). There was no significant difference between CR of PTF and Post-op both in MT (P = 0.122) and ML/L(P = 0.068) groups. Correlation and linear regression analyses showed that PTF provided the highest correlation of the four methods, with the postoperative angle both in MT(r = 0.957) and MT/L group (r = 0.779).Conclusion. To our knowledge, this was the first report about using precisely controlled bidirectional correction forces for curve flexibility evaluation. Although it did not achieve the best CR among the four methods studied, correlation and regression analyses confirmed that PTF was a more stable and accurate method to predict flexibility. We believe that further exploration of a more rational push-traction force ratio would help obtain a better flexibility.

PMID: 21221052 [PubMed – as supplied by publisher]