Essential lordosis revisited

2020 ◽  
Vol 102-B (4) ◽  
pp. 513-518 ◽  
Author(s):  
Oded Hershkovich ◽  
Areena D’Souza ◽  
Paul R. P. Rushton ◽  
Ifesemen S. Onosi ◽  
Wai Weng Yoon ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Outcome Group ◽  
Confounding Variables ◽  
Significant Correction ◽  
Screw Density ◽  
Proximal Junctional Failure ◽  
Group 2 ◽  
Upper Instrumented Vertebra ◽  
Coronal Correction ◽  
Vertebral Wedging

Aims Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. Methods A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression. Results Of the 95 patients, 71.6% (68) had a thoracic correction of > 60%. Most (97.8%) had metal density < 80%, while thoracic flexibility > 50% was found in 30.5% (29). Preoperative hypokyphosis (< 20°) was present in 25.3%. A postoperative thoracic hypokyphosis was four times more likely to occur in patients with thoracic correction ≥ 60% (odds ratio (OR) 4.08; p = 0.005), after adjusting for confounding variables. This association was not affected by metal density, thoracic flexibility, LIV, UIV, age, or sex. Conclusion Our study supports the ‘essential lordosis’ hypothesis of Roaf and Dickson, i.e. with a greater ability to translate the apical vertebra towards the midline, there is a commensurate lengthening of the anterior column due to the vertebral wedging. Cite this article: Bone Joint J 2020;102-B(4):513–518.

Development and Validation of the Questionnaire of Satisfaction with Perioperative Anesthetic Care for General and Regional Anesthesia in Taiwanese Patients

2011 ◽  
Vol 114 (5) ◽  
pp. 1064-1075 ◽  
Author(s):  
Wui-Chiu Mui ◽  
Chia-Ming Chang ◽  
Kong-Fah Cheng ◽  
Tak-Yu Lee ◽  
Kwok-On Ng ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Patient Satisfaction ◽  
Regional Anesthesia ◽  
Anesthetic Care ◽  
Anesthesia Group ◽  
Confounding Variables ◽  
Group 3 ◽  
Group 2 ◽  
Nomological Validity ◽  
Group 1

Background To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. Methods We used a six-factor 32-item pilot questionnaire developed in our previous study as our starting point in this study. Exploratory factor analysis of the pilot questionnaire for factor structure generation was performed in general anesthesia patients (group 1, n = 320) and resulted in the generation of the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq). Confirmatory factor analysis of the PSPACq in general anesthesia (group 2, n = 565) and regional anesthesia (group 3, n = 225) patients was performed for validation and cross-validation of the PSPACq model, respectively. The confounding variables and the patient loyalty effects on PSPACq scores were analyzed to evaluate the nomological validity of the PSPACq. Result Exploratory factor analysis of the pilot questionnaire in group 1 resulted in the development of the PSPACq (a seven-factor 30-item model). The standardized coefficients and indexes for the assessment of fit of the PSPACq model in group 2 (validation) and group 3 (cross-validation) patients revealed a well-fitting model. The results of the loyalty scores and confounding variables support the nomological validity of the PSPACq. Conclusions A valid and reliable questionnaire (PSPACq) with Taiwanese culture characteristics was developed and is suitable for testing of patient satisfaction with perioperative anesthesia care for patients receiving general or regional anesthesia for their surgery.

Abstract P659: Pre-Stroke Chads 2 Scores Should Be Associated With Onset Severity and Functional Outcome in Acute Stroke Patients With Atrial Fibrillation During Oral Anticoagulants: A Sub-Analysis of PASTA Registry Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kenichiro Sakai ◽  
Satoshi Suda ◽  
Masayuki Ueda ◽  
Yasuyuki Iguchi ◽  
Yoshiki Yagita ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Oral Anticoagulants ◽  
Multivariate Logistic Regression Analysis ◽  
Cardioembolic Stroke ◽  
Nihss Score ◽  
Excellent Outcome ◽  
Outcome Group ◽  
Group 2 ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: The impact of CHADS 2 score on neurological severity in patients with stroke during oral anticoagulant (OAC) has not yet been elucidated. We investigated the association between pre-stroke CHADS 2 score and severity on admission and functional outcome in acute cardioembolic stroke due to AF during OAC. Methods: We conducted an investigator-initiated, multicenter, prospective, observational cohort study, PASTA registry. One thousand forty-three patients with transient ischemic attack, ischemic stroke, and ICH who were taking OACs were prospectively enrolled in 25 medical institutions throughout Japan. We compared the clinical characteristics including severity onset and discharge outcome between low CHADS 2 score group (<2), and high CHADS 2 score group (≥2) in patients with cardioembolic stroke due to AF. Result: A total of 548 patients (237 women; median age 80 [quartiles 74-85] years) were enrolled. Of these, there were 76 patients (14%) in low CHADS 2 group and 472 (86%) in high CHADS 2 score group (Fig A). Along with increase of pre-stroke CHADS 2 score, NIHSS score was gradually increased (Fig B). Low CHADS 2 score group was associate with good outcome than high CHADS 2 group (p<0.001, Fig C). Age (p<0.001), male (p<0.001), pre-stroke CHADS 2 score (p<0.001), and initial NIHSS score (p<0.001) were significantly higher in non-excellent outcome (mRS≥2) group than excellent outcome group (mRS<2). In contrast, creatinine clearance and body weight were higher in excellent outcome group (Both p<0.001). Multivariate logistic regression analysis indicated that high pre-stroke CHADS 2 score independently associated with higher NIHSS score (NIHSS score≥6; OR 1.55, 95%CI 1.02-2.36, p=0.041) and non-excellent outcome (OR 1.94, 95%CI 1.01-3.80, p=0.047). Conclusion: The present study suggests that the pre-stroke CHADS 2 score should be useful for the prediction of clinical outcomes in patients with cardioembolic stroke due to AF even taking OAC.

Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury

2008 ◽  
Vol 108 (5) ◽  
pp. 943-949 ◽  
Author(s):  
Chi Long Ho ◽  
Chee Meng Wang ◽  
Kah Keow Lee ◽  
Ivan Ng ◽  
Beng Ti Ang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Reactivity Index ◽  
Outcome Group ◽  
The Mean ◽  
Group 2 ◽  
Biochemical Indices ◽  
Group 1

Object This study addresses the changes in brain oxygenation, cerebrovascular reactivity, and cerebral neurochemistry in patients following decompressive craniectomy for the control of elevated intracranial pressure (ICP) after severe traumatic brain injury (TBI). Methods Sixteen consecutive patients with isolated TBI and elevated ICP, who were refractory to maximal medical therapy, underwent decompressive craniectomy over a 1-year period. Thirteen patients were male and 3 were female. The mean age of the patients was 38 years and the median Glasgow Coma Scale score on admission was 5. Results Six months following TBI, 11 patients had a poor outcome (Group 1, Glasgow Outcome Scale [GOS] Score 1–3), whereas the remaining 5 patients had a favorable outcome (Group 2, GOS Score 4 or 5). Decompressive craniectomy resulted in a significant reduction (p < 0.001) in the mean ICP and cerebrovascular pressure reactivity index to autoregulatory values (< 0.3) in both groups of patients. There was a significant improvement in brain tissue oxygenation (PbtO2) in Group 2 patients from 3 to 17 mm Hg and an 85% reduction in episodes of cerebral ischemia. In addition, the durations of abnormal PbtO2 and biochemical indices were significantly reduced in Group 2 patients after decompressive craniectomy, but there was no improvement in the biochemical indices in Group 1 patients despite surgery. Conclusions Decompressive craniectomy, when used appropriately in protocol-driven intensive care regimens for the treatment of recalcitrant elevated ICP, is associated with a return of abnormal metabolic parameters to normal values in patients with eventually favorable outcomes.

scholarly journals Implant Distribution Versus Implant Density in Lenke Type 1 Adolescent Idiopathic Scoliosis: Does the Position of the Screw Matter?

2020 ◽  
pp. 219256822094145
Author(s):  
Brian L. Dial ◽  
Valentine R. Esposito ◽  
Anthony A. Catanzano ◽  
Robert D. Fitch ◽  
Robert K. Lark
Keyword(s):  
Pedicle Screw ◽  
Multivariable Analysis ◽  
Deformity Correction ◽  
Concave Side ◽  
Convex Side ◽  
Coronal Balance ◽  
Screw Density ◽  
Coronal Correction ◽  
Implant Density

Study Design: Retrospective study. Objective: Previous studies have demonstrated that increased implant density (ID) results in improved coronal deformity correction. However, low-density constructs with strategically placed fixation points may achieve similar coronal correction. The purpose of this study was to identify key zones along the spinal fusion where high ID statistically correlated to improved coronal deformity correction. Our hypothesis was that high ID within the periapical zone would not be associated with increased percent Cobb correction. Methods: We identified patients with Lenke type 1 curves with a minimum 2-year follow up. The instrumented vertebral levels were divided into 4 zones: (1) cephalad zone, (2) caudal zone, (3) apical zone, and (4) periapical zone. High and low percent Cobb correction groups were compared, high percent Cobb group was defined as percent correction >67%. Total ID, total concave ID, total convex ID, and ID within each zone of the curve were compared between the groups. A multivariable analysis was performed to identify independent predictors for coronal correction. Subsequently increased and decreased thoracic kyphosis (TK) groups were compared, increased TK was defined as post-operative TK being larger than preoperative TK and decreased TK was defined as post-operative TK being less than preoperative TK. Results: The cohort included 68 patients. The high percent Cobb group compared with the low percent Cobb group had significantly greater ID for the entire construct, the total concave side, the total convex side, the apical convex zone, the periapical zone, and the cephalad concave zone. The high percent Cobb group had greater pedicle screw density for the total construct, total convex side, and total concave side. In the multivariate model ID and pedicle screw density remained significant for percent Cobb correction. Ability to achieve coronal balance was not statistically correlated to ID ( P = .78). Conclusions: Increased ID for the entire construct, the entire convex side, the entire concave side, and within each spinal zone was associated with improved percent Cobb correction. The ability to achieve coronal balance was not statistically influence by ID. The results of this study support that increasing ID along the entire length of the construct improves percent Cobb correction.

scholarly journals Is mercury in Tibetan Medicine toxic? Clinical, neurocognitive and biochemical results of an initial cross-sectional study

2016 ◽  
Vol 242 (3) ◽  
pp. 316-332 ◽  
Author(s):  
Sarah Sallon ◽  
Yahav Dory ◽  
Yazeed Barghouthy ◽  
Tsewang Tamdin ◽  
Rigzin Sangmo ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Tibetan Medicine ◽  
Atomic Fluorescence Spectrometry ◽  
Mercury Toxicity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Treatment Groups ◽  
Confounding Variables ◽  
Group 2 ◽  
Group 1

Mercury an important therapeutic substance in Tibetan Medicine undergoes complex “detoxification” prior to inclusion in multi-ingredient formulas. In an initial cross-sectional study, patients taking Tibetan Medicine for various conditions were evaluated for mercury toxicity. Two groups were identified: Group 1, patients taking “ Tsothel” the most important detoxified mercury preparation and Group 2, patients taking other mercury preparations or mercury free Tibetan Medicine. Atomic fluorescence spectrometry of Tibetan Medicine showed mercury consumption 130 µg/kg/day (Group 1) and 30 µg/kg/day (Group 2) ( P ≤ 0.001), levels above EPA (RfDs) suggested threshold (0.3 µg/kg /day) for oral chronic exposure. Mean duration of Tibetan Medicine treatment was 9 ± 17 months (range 3–116) (Group 1) and 5 ± 1.96 months (range 1–114) (Group 2) (NS) with cumulative days of mercury containing Tibetan Medicine, 764 days ± 1214 (range 135–7330) vs. 103 days ± 111 (range 0–426), respectively ( P ≤ 0.001). Comparison of treatment groups with healthy referents (Group 3) not taking Tibetan Medicine showed no significant differences in prevalence of 23 non-specific symptoms of mercury toxicity, abnormal neurological, cardiovascular and dental findings and no correlation with mercury exposure variables; consumption, cumulative treatment days, blood/ urine Hg. Liver and renal function tests in treatment groups were not significantly increased compared to referents, with mean urine Beta2 Microglobulin within the normal range and not significantly associated with Hg exposure variables after correcting for confounding variables. Neurocognitive testing showed no significant intergroup differences for Wechsler Memory Scale, Grooved Pegboard, Visual Retention, but Group1 scores were better for Mini-Mental, Brief Word Learning, Verbal Fluency after correcting for confounding variables. These results suggest mercury containing Tibetan Medicine does not have appreciable adverse effects and may exert a possible beneficial effect on neurocognitive function. Since evidence of mercury as a toxic heavy metal, however, is well known, further analysis of literature on mercury use in other Asian traditional systems is highly suggested prior to further studies.

scholarly journals The Utility of the Callosal/Supratentorial-Supracallosal Area Ratio to Evaluate Corpus Callosum Morphometry in Children

2020 ◽  
Author(s):  
Mehmet Öztürk ◽  
Emine Uysal ◽  
Halil İbrahim Duran ◽  
Zuhal İnce Bayramoğlu ◽  
Abidin Kılınçer
Keyword(s):  
Corpus Callosum ◽  
Sagittal Plane ◽  
Pediatric Population ◽  
Age Group ◽  
Age And Gender ◽  
Mean Values ◽  
Group 3 ◽  
Group 2 ◽  
And Gender ◽  
Group 1

Objective: To perform morphometric analysis of corpus callosum (CC) by using callosal area (CA), supratentorial-supracallosal area (SSA) and CA/SSA parameters in a healthy pediatric population and to investigate changes according to age and gender. Method: Method: This retrospective study included a total of 313 children (154 boys, 159 girls) aged between 3-17 years. The cases were divided into three groups according to age: 3-6 years (Group 1) (pre-school), 7-12 years (Group 2) (preadolescent) and 13-17 years (Group 3) (adolescent). CA and SSA were measured on the mid-sagittal plane on T1-weighted images. CA/ SSA index was calculated. Differences in age, CA, SSA, and ratio parameters among the gender groups were compared using the Mann-Whitney U or the t-test. Results: Median values of CA (p= 0.002), mean values of SSA (p=0.001) and CA/SSA ratios (p= 0.04) were significantly higher in boys compared to girls. The median CA and mean CA/SSA ratios in Group 3 were significantly higher than Groups 1 and 2 (p= 0.001). Mean CA/SSA ratio values of boys and girls in Age Group 3 were significantly higher than Group 1 (p= 0.001) and significantly higher than Age Group 2 in girls. There were highly significant positive correlations of age with CA (p=0.001, r=0.47), SSA (p=0.028, r=0.12) and CA/SSA ratio (p=0.001, r=042). There was a highly significant and positive correlation between CA and SSA (p=0.001, r=0.25) and CA/SSA ratio (p=0.001, r=0.87). Conclusion: CA, SSA, and CA/ SSA ratio values in children are affected by age and gender. These parameters can be used as reference values for the diagnosis of congenital and acquired pathologies affecting the corpus callosum.

scholarly journals Proximal junctional failure prevention in adult spinal deformity surgery utilizing interlaminar fixation constructs

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Alan H. Daniels ◽  
Shyam A. Patel ◽  
Daniel B.C. Reid ◽  
Burke Gao ◽  
Eren O. Kuris ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Neurological Injury ◽  
Spinal Deformity Surgery ◽  
Proximal Junctional Failure ◽  
Upper Instrumented Vertebra ◽  
Tissue Trauma ◽  
Posterior Soft Tissue ◽  
Junctional Kyphosis

Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs. We describe placement of an interlaminar fixation construct at the upper instrumented vertebra which may decrease PJK/PJF severity, and is placed with little additional operative time and minimal posterior soft tissue trauma.

Correlation of vertebral trabecular attenuation in Hounsfield units and the upper instrumented vertebra with proximal junctional failure after surgical treatment of degenerative lumbar disease

2020 ◽  
pp. 1-8
Author(s):  
Qi Wang ◽  
Chi Wang ◽  
Xiaobo Zhang ◽  
Fanqi Hu ◽  
Wenhao Hu ◽  
...  
Keyword(s):  
Roc Curve ◽  
Curve Analysis ◽  
Rank Test ◽  
Hounsfield Units ◽  
Roc Curve Analysis ◽  
Free Survival ◽  
Log Rank Test ◽  
Degenerative Lumbar Disease ◽  
Proximal Junctional Failure ◽  
Upper Instrumented Vertebra

OBJECTIVEThe aim of this study was to investigate whether bone mineral density (BMD) measured in Hounsfield units (HUs) is correlated with proximal junctional failure (PJF).METHODSA retrospective study of 104 patients with adult degenerative lumbar disease was performed. All patients underwent posterior instrumented fusion of 4 or more segments and were followed up for at least 2 years. Patients were divided into two groups on the basis of whether they had mechanical complications of PJF. Age, sex ratio, BMI, follow-up time, upper instrumented vertebra (UIV), lower instrumented vertebra, and vertebral body osteotomy were recorded. The spinopelvic parameters were measured on early postoperative radiographs. The HU value of L1 trabecular attenuation was measured on axial and sagittal CT scans. Statistical analysis was performed to compare the difference of continuous and categorical variables. Receiver operating characteristic (ROC) curve analysis was used to obtain attenuation thresholds. A Kaplan-Meier curve and log-rank test were used to analyze the differences in PJF-free survival. Multivariate analysis via a Cox proportional hazards model was used to analyze the risk factors.RESULTSThe HU value of L1 trabecular attenuation in the PJF group was lower than that in the control group (p < 0.001). The spinopelvic parameter L4–S1 lordosis was significantly different between the groups (p = 0.033). ROC curve analysis determined an optimal threshold of 89.25 HUs (sensitivity = 78.3%, specificity = 80.2%, area under the ROC curve = 0.799). PJF-free survival significantly decreased in patients with L1 attenuation ≤ 89.25 HUs (p < 0.001, log-rank test). When L1 trabecular attenuation was ≤ 89.25 HUs, PJF-free survival in patients with the UIV at L2 was the lowest, compared with patients with their UIV at the thoracolumbar junction or above (p = 0.028, log-rank test).CONCLUSIONSHUs could provide important information for surgeons to make a treatment plan to prevent PJF. L1 trabecular attenuation ≤ 89.25 HUs measured by spinal CT scanning could predict the incidence of PJF. Under this condition, the UIV at L2 significantly increases the incidence of PJF.

scholarly journals The higher the better? Defining the optimal beta-lactam target for critically ill patients to reach infection resolution and improve outcome

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Christina Scharf ◽  
Uwe Liebchen ◽  
Michael Paal ◽  
Max Taubert ◽  
Michael Vogeser ◽  
...  
Keyword(s):  
Liver Function ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Beta Lactam ◽  
Target Attainment ◽  
Outcome Group ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Objectives Beta-lactam antibiotics are often subject to therapeutic drug monitoring, but breakpoints of target attainment are mostly based on expert opinions. Studies that show a correlation between target attainment and infection resolution are missing. This analysis investigated whether there is a difference in infection resolution based on two breakpoints of target attainment. Methods An outcome group out of 1392 critically ill patients treated with meropenem or piperacillin-tazobactam was formed due to different selection criteria. Afterwards, three groups were created: group 1=free drug concentration (f) was < 100% of the time (T) above the minimal inhibitory concentration (MIC) (< 100% fT >MIC), group 2=100% fT >MIC<4xMIC, and group 3=100% fT >4xMIC. Parameters for infection control, renal and liver function, and estimated and observed in-hospital mortality were compared between those groups. Statistical analysis was performed with one-way analysis of variance, Tukey post hoc test, U test, and bivariate logistic regression. Results The outcome group consisted of 55 patients (groups 1–3, 17, 24, and 14 patients, respectively). Patients allocated to group 2 or 3 had a significantly faster reduction of the C-reactive protein in contrast to patients allocated to group 1 (p = 0.033 and p = 0.026). Patients allocated to group 3 had a worse renal function, a higher Acute Physiology and Chronic Health Evaluation (APACHE II) score, were older, and had a significantly higher in-hospital mortality compared to group 1 (p = 0.017) and group 2 (p = 0.001). The higher mortality was significantly influenced by worse liver function, higher APACHE II, and higher Sequential Organ Failure Assessment (SOFA) score and norepinephrine therapy. Conclusion Achieving the target 100% fT >MIC leads to faster infection resolution in the critically ill. However, there was no benefit for patients who reached the highest target of 100% fT >4xMIC, although the mortality rate was higher possibly due to confounding effects. In conclusion, we recommend the target 100% fT >MIC<4xMIC for critically ill patients. Trial registration NCT03985605

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