Improvement in Pulmonary Function of Chronic Obstructive Pulmonary Disease (COPD) Patients With Osteoporotic Vertebral Compression Fractures (OVCFs) After Kyphoplasty Under Local Anesthesia.

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Improvement in Pulmonary Function of Chronic Obstructive Pulmonary Disease (COPD) Patients With Osteoporotic Vertebral Compression Fractures (OVCFs) After Kyphoplasty Under Local Anesthesia.

Int Surg. 2015 Mar;100(3):503-9

Authors: Sheng S, Zhenzhong S, Weimin J, Yimeng W, Qudong Y, Jinhui S

Abstract
To investigate the changes in respiratory function of COPD patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty (KP). Pain scores, pulmonary function parameters (PFT), and local kyphotic angle (LKA) were measured in 31 older patients (25 women, 6 men) with OVCFs before, 3 days after and 3 months after kyphoplasty. The preoperative and postoperative (3 days, 3 months) PFT parameters were as follows: % pred FVC, 74.33 ± 12.35, 85.23.8 ± 13.23, and 84.86 ± 14.01; % pred FEV1, 60.23 ± 11.2, 60.02 ± 11.90, and 60.78 ± 12.70; FEV1/FVC ratio (%), 68.22 ± 16.74, 59.56 ± 13.23, and 60.77 ± 12.28, % pred MVV 52.46 ± 14.37, 55.23 ± 15.68, and 62.12 ± 14.48, respectively. The preoperative mean VAS score was 8.01 ± 1.41 and significantly decreased to 2.52 ± 0.89 and 2.34 ± 0.78 at 3 days, 3 months after kyphoplasty, respectively. The preoperative local kyphotic angle degree was 21.96 ± 5.75°, significantly decreased to 13.48 ± 6.12° 3 days after KP, and maintained 3 month after KP. The decrease in the VAS scores correlated with the PFT parameters; however, there were no significant correlations between the PFT parameters and the LKA, the VAS scores and the LKA. Kyphoplasty under local anesthesia is a safety treatment for the COPD patients with OVCFS, and is able to improve the lung function impaired by OVCFs.

PMID: 25785335 [PubMed – indexed for MEDLINE]

[Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital].

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[Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital].

Nutr Hosp. 2014 Dec 01;30(6):1289-94

Authors: Prior-Sánchez I, Herrera-Martínez AD, Tenorio Jiménez C, Molina Puerta MJ, Calañas Continente AJ, Manzano García G, Gálvez Moreno MÁ

Abstract
BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians.
OBJECTIVE: To analyse the characteristics of ALS patients at the moment of PEG placement and their progression.
METHODS AND MATERIALS: Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15.
RESULTS: 37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement.
CONCLUSIONS: There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.

PMID: 25433110 [PubMed – indexed for MEDLINE]

Spinal intra-operative three-dimensional navigation: correlation between clinical and absolute engineering accuracy.

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Spinal intra-operative three-dimensional navigation: correlation between clinical and absolute engineering accuracy.

Spine J. 2016 Oct 21;:

Authors: Guha D, Jakubovic R, Gupta S, Alotaibi NM, Cadotte D, da Costa LB, George R, Heyn C, Howard P, Kapadia A, Klostranec JM, Phan N, Tan G, Mainprize TG, Yee A, Yang VX

Abstract
BACKGROUND CONTEXT: Spinal intra-operative computer-assisted navigation (CAN) may guide pedicle screw placement. CAN techniques have been reported to reduce pedicle screw breach rates across all spinal levels. However, definitions of screw breach vary widely across studies, if reported at all. The absolute quantitative error of spinal navigation systems is theoretically a more precise and generalizable metric of navigation accuracy. It has also been computed variably, and reported in fewer than a quarter of clinical studies of CAN-guided pedicle screw accuracy.
PURPOSE: To characterize the correlation between clinical pedicle screw accuracy, based on post-operative imaging, and absolute quantitative navigation accuracy.
STUDY DESIGN/SETTING: Retrospective review of a prospectively-collected cohort.
PATIENT SAMPLE: 30 patients undergoing first-time posterior cervical/thoracic/lumbar/sacral instrumented fusion ± decompression, guided by intra-operative three-dimensional CAN.
OUTCOME MEASURES: Clinical/radiographic screw accuracy (Heary and 2mm classifications); absolute quantitative navigation accuracy (translational and angular error in axial and sagittal planes).
METHODS: We reviewed a prospectively-collected series of 209 pedicle screws placed with CAN guidance. Each screw was graded clinically by multiple independent raters using the Heary and 2mm classifications. Clinical grades were dichotomized per convention. The absolute accuracy of each screw was quantified by the translational and angular error in each of the axial and sagittal planes.
RESULTS: Acceptable screw accuracy was achieved for significantly fewer screws based on 2mm grade vs. Heary grade (92.6% vs. 95.1%, p = 0.036), particularly in the lumbar spine. Inter-rater agreement was good for the Heary classification and moderate for the 2mm grade, significantly greater among radiologists than surgeon raters. Mean absolute translational/angular accuracies were 1.75mm/3.13° and 1.20mm/3.64° in the axial and sagittal planes, respectively. There was no correlation between clinical and absolute navigation accuracy.
CONCLUSIONS: Radiographic classifications of pedicle screw accuracy vary in sensitivity across spinal levels, as well as in inter-rater reliability. Correlation between clinical screw grade and absolute navigation accuracy is poor, as surgeons appear to compensate for navigation registration error. Future studies of navigation accuracy should report absolute translational and angular errors. Clinical screw grades based on post-operative imaging may be more reliable if performed in multiple by radiologist raters.

PMID: 27777052 [PubMed – as supplied by publisher]

Does Lordotic Angle of Cage Determine Lumbar Lordosis in Lumbar Interbody Fusion?

Does Lordotic Angle of Cage Determine Lumbar Lordosis in Lumbar Interbody Fusion?

Spine (Phila Pa 1976). 2016 Oct 24;

Authors: Hong TH, Cho KJ, Kim YT, Park JW, Seo BH, Kim NC

Abstract
STUDY DESIGN: Retrospective, radiological analysis OBJECTIVE.: To determine that 15° lordotic angle cages create higher lumbar lordosis in open transforaminal lumbar interbody fusion (TLIF) than 4° and 8° cages.
SUMMARY OF BACKGROUND DATA: Restoration of lumbar lordosis is important to obtain good outcome after lumbar fusion surgery. Various shapes and angles of cages in interbody fusion have been used, however, it is not proved that lordotic angle of cages determine lumbar lordosis.
METHODS: Sixty-seven patients were evaluated after TLIF using 15° cages and screw instrumentation. For comparison, TLIF using 4° lordotic angle cages in 65 patients and 8° cages in 49 patients were analyzed. Lumbar lordosis angles, segmental lordosis angles, disc height, and bony union rate were measured on the radiographs.
RESULTS: The lumbar lordosis was 31.1° preoperatively, improved to 42.9° postoperatively and decreased to 36.4° at the last follow-up in the 15° group. It was 35.8° before surgery, corrected to 41.5° after surgery, and changed to 33.6° at the last follow-up in the 4° group. In the 8° group, it was 32.7° preoperatively, improved to 39.1° postoperatively and decreased to 34.5° at the last follow-up. These changes showed statistical significances (p < 0.001). The segmental lordosis at L4-5 was 6.6° before surgery, 13.1° after surgery, and 9.8° at the last follow-up in the 15° group. It was 6.9°, 9.5°, and 6.2° in the 4° group and 6.7°, 9.8°, and 8.1° in the 8° group, respectively (p < 0.001). The disc height restoration was better in the 15° group than in the 4° and 8° groups (p < 0.001). Bony union rate was not significant among the three groups (p = 0.087).
CONCLUSIONS: The lordotic angle of the cages determined restoration of lumbar lordosis after transforaminal lumbar interbody fusion. Cages with sufficient lordotic angle showed better restoration of lumbar lordosis as well as prevention of loss of correction.
LEVEL OF EVIDENCE: 4.

PMID: 27779605 [PubMed – as supplied by publisher]

Factors Affecting Length of Stay and Complications After Elective Anterior Cervical Discectomy and Fusion: A Study of 2164 Patients From The American College of Surgeons National Surgical Quality Improvement Project Database (ACS NSQIP).

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Factors Affecting Length of Stay and Complications After Elective Anterior Cervical Discectomy and Fusion: A Study of 2164 Patients From The American College of Surgeons National Surgical Quality Improvement Project Database (ACS NSQIP).

Clin Spine Surg. 2016 Feb;29(1):E34-42

Authors: Gruskay JA, Fu M, Basques BA, Bohl DD, Buerba RA, Webb ML, Grauer JN

Abstract
STUDY DESIGN: Retrospective review of the prospective American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database with 30-day follow-up of 2164 patients undergoing elective anterior cervical discectomy and fusion (ACDF).
OBJECTIVE: To determine factors independently associated with increased length of stay (LOS) and complications after ACDF to facilitate preoperative planning and setting of realistic expectations for patients and providers.
SUMMARY OF BACKGROUND DATA: The effect of individual preoperative factors on LOS and complications has been evaluated in small-scale studies. Large database analysis with multivariate analysis of these variables has not been reported.
METHODS: The ACS NSQIP database from 2005 to 2010 was queried for patients undergoing ACDF procedures. Preoperative and perioperative variables were collected. Multivariate regression determined significant predictors (P<0.05) of extended LOS and complications.
RESULTS: Average LOS was 2.0±4.0 days (mean±SD) with a range of 0-103 days. By multivariate analysis, age 65 years and above, functional status, transfer from facility, preoperative anemia, and diabetes were the preoperative factors predictive of extended LOS. Major complications, minor complications, and extended surgery time were the perioperative factors associated with increased LOS. The elongating effect of these variables was determined, and ranged from 0.5 to 5.0 days. Seventy-one patients (3.3%) had a total of 92 major complications, including return to operating room (40), venous thrombotic events (13), respiratory (21), cardiac (6), mortality (5), sepsis (4), and organ space infection (3). Multivariate analysis determined ASA score ≥3, preoperative anemia, age 65 years and above, extended surgery time, and male sex to be predictive of major complications (odds ratios ranging between 1.756 and 2.609). No association was found between levels fused and LOS or complications.
CONCLUSION: Extended LOS after ACDF is associated with factors including age, anemia, and diabetes, as well as the development of postoperative complications. One in 33 patients develops a major complication postoperatively, which are associated with an increased LOS of 5 days.

PMID: 24525748 [PubMed – indexed for MEDLINE]