scholarly journals PREVALENCE AND MANAGEMENT OF REFRACTORY MERALGIA PARESTHETICA IN LUMBAR SPINE SURGERY: 5 YEARS OF EXPERIENCE

2020 ◽  
Vol 19 (1) ◽  
pp. 40-43
Author(s):  
JOSE AUGUSTO MALHEIROS ◽  
CELIA MARIA DE OLIVEIRA ◽  
ALUIZIO AUGUSTO ARANTES JUNIOR ◽  
JONAS SOARES SILVA SANTOS ◽  
SEBASTIÃO NATANAEL SILVA GUSMÃO
Keyword(s):  
Body Mass Index ◽  
Neuropathic Pain ◽  
Lumbar Spine ◽  
Body Mass ◽  
Posterior Approach ◽  
Case Series ◽  
Inguinal Ligament ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Meralgia Paresthetica

ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.

P64. Impact of body mass index on opioid consumption in lumbar spine fusion surgery

2021 ◽  
Vol 21 (9) ◽  
pp. S170-S171
Author(s):  
Taryn E. LeRoy ◽  
Andrew S. Moon ◽  
Marissa Gedman ◽  
Jessica P. Aidlen ◽  
Ashley L. Rogerson
Keyword(s):  
Body Mass Index ◽  
Lumbar Spine ◽  
Body Mass ◽  
Spine Fusion ◽  
Opioid Consumption ◽  
Fusion Surgery ◽  
Lumbar Spine Fusion

scholarly journals Posterior malleolar fractures. New classification and treatment algorithm

2020 ◽  
Vol 14 (3) ◽  
pp. 254-259
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago
Keyword(s):  
Posterior Approach ◽  
Treatment Algorithm ◽  
Case Series ◽  
Fracture Pattern ◽  
Joint Surface ◽  
Medial Malleolus ◽  
New Classification ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolus

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.

The Influence of Body Mass Index in Obese and Morbidly Obese Patients on Complications and 30- and 90-day Readmissions Following Lumbar Spine Fusion

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Xiao T. Chen ◽  
Shane Shahrestani ◽  
Alexander M. Ballatori ◽  
Andy Ton ◽  
Zorica Buser ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Lumbar Spine ◽  
Body Mass ◽  
Spine Fusion ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Lumbar Spine Fusion

scholarly journals Increased body mass index percentile is associated with decreased epiphyseal tubercle size in asymptomatic children and adolescents with healthy hips

2020 ◽  
Vol 14 (3) ◽  
pp. 167-174
Author(s):  
Shayan Hosseinzadeh ◽  
Ata M. Kiapour ◽  
Daniel A. Maranho ◽  
Seyed Alireza Emami ◽  
Patricia Miller ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Children And Adolescents ◽  
Body Mass ◽  
Slipped Capital Femoral Epiphysis ◽  
Level Of Evidence ◽  
Age Related ◽  
Asymptomatic Children ◽  
Control And Prevention ◽  
Male Patients ◽  
3D Software

Purpose To investigate whether body mass index (BMI) percentile impacts the morphology of the capital femoral epiphysis in children and adolescents without hip disorders. Methods We assessed 68 subjects with healthy hips who underwent a pelvic CT for evaluation of appendicitis. There were 32 male patients (47%) and the mean age was 11.6 years (sd 2.3). The BMI (k/m2) was calculated for sex- and age-related percentiles according to the Centers for Disease Control and Prevention growth charts. CT images were segmented, and the epiphysis and metaphysis were reformatted using 3D software. We measured the epiphyseal tubercle (height, width and length), the metaphyseal fossa (depth, width and length) and the peripheral cupping of the epiphysis. All measurements were normalized to the diameter of the epiphysis. Pearson’s correlation analysis was used to assess the correlations between the variables measured and BMI percentile adjusted for age. Results Following adjustment to age, increased BMI correlated to decreased tubercle height (r =-0.34; 95% confidence interval (CI) -0.53 to -0.11; p = 0.005), decreased tubercle length (r = -0.32; 95%CI -0.52 to -0.09; p = 0.008) and decreased tubercle width (r = -0.3; 95% CI -0.5 to -0.07; p = 0.01). There was no correlation between BMI and metaphyseal fossa and epiphyseal cupping measurements. Conclusion The association between increased BMI percentile and decreased epiphyseal tubercle size, without changes of the metaphyseal fossa and peripheral cupping suggests another morphological change of the femur that may be associated with decreased growth plate resistance to shear stress. Further study is necessary to investigate whether the epiphyseal tubercle size plays a role in the pathogenesis of slipped capital femoral epiphysis in obese children and adolescents. Level of Evidence Level IV

scholarly journals Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774391 ◽  
Author(s):  
Michael Jernick ◽  
Edward Walker Gallego ◽  
Michael Nuzzo
Keyword(s):  
Body Mass Index ◽  
Magnetic Resonance ◽  
Case Series ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Office Setting ◽  
Radiology Reports ◽  
Magnetic Resonance Arthrogram ◽  
Patient Variables ◽  
Age And Sex

Background: Ultrasound (US)–guided intra-articular hip injections have been proposed in the literature to be accurate, reliable, and safe alternatives to fluoroscopy-guided injections. Purpose: To evaluate the accuracy of US-guided magnetic resonance (MR) arthrogram injections of the hip performed in the office setting by a single orthopaedic surgeon and elucidate the potential effects that patient age, sex, and body mass index (BMI) have on contrast placement. Study Design: Case series; Level of evidence, 4. Methods: From a review of the senior author’s office database, 89 patients (101 hips) who had US-guided MR arthrogram injections performed between December 2014 and June 2016 were identified. Official radiology reports were evaluated to determine whether extra-articular contrast was noted. Patient variables, including BMI, age, and sex, were evaluated between patients who had inappropriately placed contrast and those who did not. Results: Of the 101 hip injections, there were 6 cases that demonstrated inadequate contrast placement within the joint, likely secondary to extravasation or incorrect placement; however, an MR arthrogram was adequately interpreted in all cases. There were no significant differences noted between those with appropriate versus inappropriate contrast placement when evaluating BMI ( P = .57), age ( P = .33), or sex ( P = .67), and neither group had an adverse event. Conclusion: US-guided injections are safe and accurate alternatives to fluoroscopy-guided injections in the office setting, with 94% accuracy. Furthermore, BMI, age, and sex did not play a statistically significant role among patients with inappropriately placed contrast.

Association of serum 25-hydroxy vitamin D and body mass index in cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6625-6625
Author(s):  
D. Gupta ◽  
K. Trukova ◽  
P. G. Vashi ◽  
A. Adams ◽  
G. M. Lambert ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Vitamin D ◽  
Cancer Patients ◽  
Body Mass ◽  
Case Series ◽  
Spearman Correlation ◽  
Dietary Recommendations ◽  
25 Hydroxy Vitamin D ◽  
The Mean ◽  
The Relationship

6625 Background: The association between vitamin D and obesity remains unsettled with studies reporting conflicting findings on the relationship between the two. This association assumes even greater importance in cancer because of the alleged role of vitamin D in cancer risk and survival. Currently, the dietary recommendations for Vitamin D do not take into account a person's body mass index (BMI). We investigated the relationship between serum 25-hydroxy-vitamin D [25(OH)D] and BMI in a large sample of cancer patients. Methods: A consecutive case series of 740 cancer patients seen at Cancer Treatment Centers of America from Jan 08 to June 08. Serum 25(OH)D was measured at presentation to the hospital. The cohort was divided in 4 BMI groups (<18.5, 18.5–24.9, 25–29.9, and >30.0 kg/m2). Correlation between 25(OH)D and BMI was evaluated using Spearman correlation coefficient. Mean 25(OH)D was compared across the 4 BMI groups using ANOVA. Linear regression was used to quantify the relationship between BMI and 25(OH)D. Results: Of 740 patients, 303 were males and 437 females. The mean age at presentation was 55.7 years (SD = 10.2). The mean BMI was 27.9 kg/m2 (SD = 6.7). Most common cancers were lung (134, 18.1%), breast (131, 17.7%), colorectal (97, 13.1%), pancreas (86, 11.6%), prostate (45, 6.1%) and ovarian (39, 5.3%). The mean serum 25(OH)D was 21.9 ng/ml (SD = 13.5). Analysis revealed that as BMI groups increased from normal to overweight or obese classifications, there was a significant decrease in 25(OH)D (Table). The Spearman correlation between 25(OH)D and BMI was -0.20 (p = 0.001). Every 1 kg/m2 increase in BMI was significantly associated with a 0.43 ng/ml decline in serum 25(OH)D (p = 0.001). Conclusions: We found that obese cancer patients (BMI >=30 kg/m2) had significantly lower levels of serum 25(OH)D as compared to nonobese patients (BMI <30 kg/m2). BMI should be taken into account when assessing a patient's vitamin D status and more aggressive vitamin D supplementation should be considered in obese cancer patients. [Table: see text] No significant financial relationships to disclose.

Comparing Tendinous and Ligamentous Ankle Pathology in Atraumatic Overweight and Nonoverweight Patients

2014 ◽  
Vol 7 (6) ◽  
pp. 449-456 ◽  
Author(s):  
Melissa M. Galli ◽  
Nicole M. Protzman ◽  
Eiran M. Mandelker ◽  
Amit Malhotra ◽  
Edward Schwartz ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Magnetic Resonance ◽  
Present Report ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Prevalence Of Obesity ◽  
Prospective Longitudinal ◽  
Prospective Longitudinal Cohort

With the increased prevalence of obesity, there has been a parallel rise in musculoskeletal disorders. However, the effect of body mass index (BMI) on pathology of the hindfoot and ankle is scarcely understood. The purpose of the present report was to compare the number of tendinous and ligamentous pathologies within the hindfoot and ankle between overweight (BMI ≥ 25.00 kg/m2) and nonoverweight (BMI < 25.00 kg/m2) atraumatic patients. We hypothesized that overweight patients would demonstrate more tendinous and ligamentous pathologies compared with their nonoverweight counterparts. Five hundred consecutive magnetic resonance images were reviewed. One hundred eight patients met the inclusion and exclusion criteria. Sixty-six patients were overweight and 42 patients were nonoverweight. Ninety-eight percent of overweight patients demonstrated pathology of a tendinous or ligamentous nature, whereas 62% of nonoverweight patients demonstrated pathology of a tendinous or ligamentous nature. Thus, the prevalence of pathology was 1.59 times higher among overweight patients compared with nonoverweight patients. Moreover, controlling for age, overweight patients demonstrated approximately twice as many tendinous and ligamentous pathologies compared with nonoverweight patients (adjusted mean ± SD = 4.44 ± 2.14 vs 1.98 ± 2.07, respectively), which was statistically significantly different ( P < .001). To definitively assess causation and the clinical evolution of hindfoot and ankle pathology, prospective, longitudinal cohort studies are warranted. Level of Evidence: Diagnostic, Level III: Case series

Midfoot Arthrodesis following Multi-Joint Stabilization with a Novel Hybrid Plating System

2012 ◽  
Vol 33 (3) ◽  
pp. 220-225 ◽  
Author(s):  
Jorge Filippi ◽  
Mark S. Myerson ◽  
Mark W. Scioli ◽  
Bryan Dale Den Hartog ◽  
David B. Kay ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Body Mass Index ◽  
Healing Rate ◽  
Case Series ◽  
The Other ◽  
Joint Disease ◽  
Retrospective Case ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Joint Gap

Background: Several methods for fixation have been described for midfoot arthrodesis. Multi-joint arthrodesis at this level can be challenging because of bone loss and deformity, making it difficult to obtain a stable construct. We present the results of a novel hybrid plating system that incorporates locked and non-locked compression screws for multi-joint arthrodesis of the midfoot. Method: A retrospective multicenter review of patients undergoing multi-joint arthrodesis with hybrid plating of the midfoot was performed to evaluate the time to radiographic arthrodesis. Hybrid plating was defined as a construct that incorporates locked and non-locked compression screws. Neuropathy was the only exclusion criteria. Radiographic arthrodesis was defined as bridging bone on one of the three standard foot radiographs in the absence of a joint gap on the other views, or by 50% or greater bridging bone on computed tomography. Etiology of the arthritis, presurgical comorbidities, body mass index, functional level and postoperative complications were evaluated. Results: Seventy-two patients were evaluated, and arthrodesis was obtained in 67 patients at 6 weeks in 27 patients, 9 weeks in 26, 12 weeks in 11, and at 16 weeks in three. In five patients at least one of the joints were not fused at 16 weeks and were considered a nonunion. Complications were present in 12 patients (17%). Conclusions: The healing rate and time to arthrodesis compared favorably to similar published studies. Based on these results, hybrid plating was a reliable and consistent alternative for fixation in midfoot arthrodesis, especially in multi-joint disease. Level of Evidence: IV; Retrospective Case Series

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