Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity.

By London Spine
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Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity.

Bone Joint J. 2014 Jan;96(1):100-5

Authors: Shapiro F, Zurakowski D, Bui T, Darras BT

Abstract
We determined the frequency, rate and extent of development of scoliosis (coronal plane deformity) in wheelchair-dependent patients with Duchenne muscular dystrophy (DMD) who were not receiving steroid treatment. We also assessed kyphosis and lordosis (sagittal plane deformity). The extent of scoliosis was assessed on sitting anteroposterior (AP) spinal radiographs in 88 consecutive non-ambulatory patients with DMD. Radiographs were studied from the time the patients became wheelchair-dependent until the time of spinal fusion, or the latest assessment if surgery was not undertaken. Progression was estimated using a longitudinal mixed-model regression analysis to handle repeated measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in 78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted longitudinal model revealed that time in a wheelchair was a highly significant predictor of the magnitude of the curve, independent of the age of the patient (p < 0.001). Scoliosis developed in virtually all DMD patients not receiving steroids once they became wheelchair-dependent, and the degree of deformity deteriorated over time. In general, scoliosis increased at a constant rate, beginning at the time of wheelchair-dependency (p < 0.001). In some there was no scoliosis for as long as three years after dependency, but scoliosis then developed and increased at a constant rate. Some patients showed a rapid increase in the rate of progression of the curve after a few years – the clinical phenomenon of a rapidly collapsing curve over a few months. A sagittal plane kyphotic deformity was seen in 37 of 60 patients (62%) with appropriate radiographs, with 23 (38%) showing lumbar lordosis (16 (27%) abnormal and seven (11%) normal). This study provides a baseline to assess the effects of steroids and other forms of treatment on the natural history of scoliosis in patients with DMD, and an approach to assessing spinal deformity in the coronal and sagittal planes in wheelchair-dependent patients with other neuromuscular disorders. Cite this article: Bone Joint J 2014;96-B:100-5.

PMID: 24395319 [PubMed – in process]

Practice Patterns in Spine Radiograph Utilization Among Doctors of Chiropractic Enrolled in a Provider Network Offering Complementary Care in the United States.

By London Spine
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Practice Patterns in Spine Radiograph Utilization Among Doctors of Chiropractic Enrolled in a Provider Network Offering Complementary Care in the United States.

J Manipulative Physiol Ther. 2013 May 8;

Authors: Bussières AE, Sales AE, Ramsay T, Hilles S, Grimshaw JM

Abstract
OBJECTIVE: Nonspecific back pain is associated with high use of diagnostic imaging in primary care, yet current evidence suggests that routine imaging of the spine is unnecessary. The objective of this study is to describe current practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in an American provider network. METHODS: A cross-sectional analysis of administrative claims data from one of the largest providers of complementary health care networks for health plans in the United States was performed. Survey data containing provider demographics were linked with routinely collected data on spine radiograph utilization and patient characteristics aggregated at the provider level. We calculated rates and variations of spine radiographs over 12 months. Negative binomial regression was performed to identify significant predictors of high radiograph utilization and to estimate the associated incidence risk ratio. RESULTS: Complete data for 6946 doctors of chiropractic and 249193 adult patients were available for analyses. In 2010, claims were paid for a total of 91542 new patient examinations and 23369 spine radiographs (including17511 ordered within 5 days of initial patient examination). The rate of spine radiographs within 5 days of an initial patient visit was 204 per 1000 new patient examinations. Significant predictors of higher radiograph utilization rates included the following: practicing in the Midwest or South US census regions, practicing in an urban or suburban setting, chiropractic school attended, and being a male provider in full-time practice with more than 20 years of experience. CONCLUSION: Chiropractic school attended and practice location were the most influential predictors of spine radiograph utilization among network chiropractors. This information may help to inform the development and evaluation of a tailored intervention to address overuse of radiograph utilization.

PMID: 23664160 [PubMed – as supplied by publisher]

Understanding the Impact of Obesity on Short-Term Outcomes and In-Hospital Costs After Instrumented Spinal Fusion.

By London Spine
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Understanding the Impact of Obesity on Short-Term Outcomes and In-Hospital Costs After Instrumented Spinal Fusion.

Neurosurgery. 2015 Sep 8;

Authors: Higgins DM, Mallory GW, Planchard R, Puffer R, Ali M, Gates M, Clifton W, Jacob JT, Curry T, Kor D, Fogelson JL, Krauss WE, Clarke MJ

Abstract
BACKGROUND: Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion.
OBJECTIVE: To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease.
METHODS: A single-institution retrospective analysis was conducted on patients with degenerative spine disease requiring instrumentation between 2008 and 2012. The 801 identified patients were grouped based on a body mass index (BMI) of <30 (nonobese, n = 478), ≥30 and <40 (obese, n = 283), and alternatively BMIs of ≥40 (morbidly obese, n = 40). Baseline characteristics, surgical outcomes and requirements, complications, and cost were compared. Logistic and linear regression analyses were used to determine the strength of association between obesity and outcomes for categorical and continuous data, respectively.
RESULTS: Significant differences were found in comorbidities between cohorts. Multivariate analysis revealed significant associations between obesity and longer anesthesia times (30 minutes, P = .008), and surgical times (24 minutes, P = .02). Additionally, there was a 2.8 times higher rate of wound complications in obese patients (4.2% vs 1.5, P = .03), and 2.5 times higher rate of major medical complications (7.8% vs 3.1, P = .01). Morbid obesity resulted in a 10 times higher rate of wound complications (P < .001). Morbid obesity resulted in a $9078 (P = .005) increase in overall cost of care.
CONCLUSION: Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.
ABBREVIATIONS: ACF, anterior cervical fusionBMI, body mass indexPCF, posterior cervical fusionTLF, thoracic and/or lumbar spinal fusion.

PMID: 26352096 [PubMed – as supplied by publisher]

The Association Between Lumbar Spine Sagittal Alignment And L4-L5 Disc Degeneration Among Asymptomatic Young Adults.

By London Spine

The Association Between Lumbar Spine Sagittal Alignment And L4-L5 Disc Degeneration Among Asymptomatic Young Adults.

Spine (Phila Pa 1976). 2016 Mar 15;

Authors: Menezes-Reis R, Bonugli GP, Dalto VF, Herrero CF, Defino HL, Nogueira-Barbosa MH

Abstract
STUDY DESIGN: Cross-sectional observational study on the relationship between the degrees of disc degeneration and sagittal alignment in asymptomatic healthy individuals.
OBJECTIVE: This study sought to determine whether the sagittal spine alignment subtype is related to the prevalence of lumbar disc degeneration.
SUMMARY AND BACKGROUND DATA: Sagittal balance and spinopelvic parameters might be risk factors for disc degeneration.
METHODS: A total of 70 asymptomatic participants (36 women and 34 men) without regular physical activity were categorized according to the four subtypes of sagittal alignment proposed by Roussouly. All participants underwent magnetic resonance imaging of the lumbar spine (1.5T) and panoramic radiography of the spine. The degree of disc degeneration was graded using T2-weighted images according to the Pfirrmann classification. Spinopelvic parameters and vertebral curvatures were measured on digital panoramic radiographs using Surgimap® software. Interobserver analyses for the Pfirrmann classification and spinopelvic parameters were assessed using the weighted Kappa and intraclass correlation coefficient (ICC), respectively.
RESULTS: The Kappa associated with disc degeneration classification was 0.79 (95% confidence intervals CIs = 0.72-0.87). The ICCs were excellent, with small CIs for all spinopelvic parameters. The Type II group (flat lordosis) showed a higher frequency of degenerated discs at L4-L5 (p = 0.03) than the Type IV group (long and curved lumbar spine). No significant differences in disc degeneration were observed among the four subtypes at the other disc levels. We found a negative, moderate correlation between the spinopelvic parameters and the occurrence of disc degeneration in the Type II group.
CONCLUSIONS: The Roussouly subtype II sagittal alignment is significantly associated with disc degeneration at L4-L5 in asymptomatic young adults. Our results support the hypothesis that spinal sagittal alignment plays a role in early disc degeneration.
LEVEL OF EVIDENCE: 3.

PMID: 26987107 [PubMed – as supplied by publisher]

Cementing the vena cava.

By London Spine

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Cementing the vena cava.
Eur J Vasc Endovasc Surg. 2015 Aug;50(2):240
Authors: Rayt HS, Nasim A
PMID: 26143101 [PubMed – indexed for MEDLINE]