scholarly journals Complications rate and risk factors in unplanned reoperation of degenerative lumbar spondylolisthesis in geriatric patients: a retrospective single-center cohort study of 33 patients

2019 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaoji Luo ◽  
Tianji Huang ◽  
Zhengxue Quan
Keyword(s):  
Risk Factors ◽  
Neurological Deficit ◽  
Geriatric Patients ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Screw Misplacement ◽  
Group A ◽  
Group B ◽  
Lumbar Spondylolisthesis ◽  
Complications Rate

Abstract Background: The study aimed to investigate the complications rate and risk factors in unplanned reoperation among geriatric patients who underwent posterior lumbar fusion(PLF) for degenerative lumbar spondylolisthesis(DLS).Methods: 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016 and 33 patients underwent unplanned reoperations who were analyzed and divided to two groups(Group A: posteriolateral fusion, Group B: intervertebral fusion). Gender, body mass index (BMI), radiographic data and clinical outcomes data were analyzed to evaluate complications rate and the risk factors for unplanned reoperations.Results: 33 patients were performed by the unplanned reoperations(3%).The patients were followed up for an average of 4.20±2.25 years (Group A)and 4.32±2.54 years(Group B)without significant difference. The significant difference was found in mean age, levels involved levels, hospital stay, surgery time, blood loss between the groups. The causes of unplanned operation were: wound infection, screw misplacement, neurological deficit, nonunion, screw fracture which were significant except the wound infection between the groups. Higher BMI (obesity), diabetes mellitus(DM), more bleeding and gender(female) were the risk factors of the complications. The cases of the screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significantly than in group B.Conclusion: The patients of higher BMI, DM, age, posteriolateral fusion, female predicted higher incidence of unplanned reoperations. The spine surgeons maybe need to pay more attention in their preoperative training and in improving surgical technique which could reduce the reoperation rate.

scholarly journals Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-centre cohort study of 33 patients

2020 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaoji Luo ◽  
Tianji Huang ◽  
Zhengxue Quan
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Wound Infection ◽  
Neurological Deficit ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Screw Misplacement ◽  
Group A ◽  
Group B ◽  
Lumbar Spondylolisthesis ◽  
Complications Rate

Abstract Background: The study aimed to investigate the complications rate of and risk factors for unplanned reoperation among elderly patients who underwent posterior lumbar fusion (PLF) for degenerative lumbar spondylolisthesis (DLS).Methods: A total of 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016; 33 patients underwent unplanned reoperations and were analysed and divided into two groups (group A: posterolateral fusion, 650 patients; group B: intervertebral fusion, 450 patients). Sex, body mass index (BMI), radiographic data and clinical outcome data were analysed to evaluate the complications rate of and the risk factors for unplanned reoperations.Results: A total of 33 patients underwent unplanned reoperations (3%). The patients were followed for an average of 4.20±2.25 years (group A) and 4.32±2.54 years (group B) without a significant difference. Significant differences were found in mean age, levels of involvement, hospital stay, surgery time, and blood loss between the groups. The causes of unplanned operation were wound infection, screw misplacement, neurological deficit, nonunion, and screw fracture, which were significant except for wound infection between the groups. Higher BMI (obesity), diabetes mellitus (DM), more bleeding and sex (female) were risk factors for complications. Cases of screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significant than those in group B.Conclusion: Patients with higher BMI, DM, older age, posterolateral fusion, and female sex predicted a higher incidence of unplanned reoperations. Spine surgeons may need to pay more attention to their preoperative training and to improving surgical techniques that could reduce the reoperation rate.

Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3613-3613 ◽  
Author(s):  
Vittorio Montefusco ◽  
Francesca Gay ◽  
Francesco Spina ◽  
Maria Teresa Ambrosini ◽  
Massimo Maniezzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Low Risk ◽  
Dental Procedure ◽  
Dental Procedures ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p<0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

scholarly journals Comparison of the clinical efficacy of two fixation methods combined with OLIF in the treatment of lumbar spondylolisthesis

2021 ◽  
Author(s):  
Xinliang Zhang ◽  
Yunshan Guo ◽  
Yibing Li
Keyword(s):  
Clinical Efficacy ◽  
Screw Fixation ◽  
Fusion Rate ◽  
Imaging Data ◽  
Fixation Methods ◽  
Post Surgery ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Lumbar Spondylolisthesis

Abstract Background To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation(PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis. Methods This is a retrospective case-control study. Patients with lumbar spondylolisthesis treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence and migration of cages, fusion rate, and surgery-related complications were compared between the two groups. Results Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at 1 week post-surgery(2.3 ± 0.5Vs3.5 ± 0.4, P = 0.01), and 3 months post-operation (2.2 ± 0.3VS 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at 3 months post-surgery(18.1 ± 2.3 mm Vs 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A was 72.0% and78.6% in group B (not statistically significant, P = 0.75). Fusions were identified in all patients at 24 months post-surgery. Conclusion Compared to PPSF, ASRSF combined with OLIF for lumbar spondylolisthesis can reduce post-operative low back pain in the early stages, maintain the height of the foramen superiorly, and improve the performance of lumbar function.

scholarly journals Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study

2018 ◽  
Vol 12 (1) ◽  
pp. 125-136 ◽  
Author(s):  
Behzad Hatami ◽  
Seyed Mohammad Hossein Kashfi ◽  
Mohammad Abbasinazari ◽  
Ehsan  Nazemalhosseini Mojarad ◽  
Mohammad Amin Pourhoseingholi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Combination Group ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
Blinded Manner ◽  
Group A ◽  
Group B ◽  
Double Blinded

Background: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) ranges between 15 and 20% among patients at high risk of developing PEP. The efficacy of indomethacin administration in the prevention of PEP is rather debatable. In the present randomized trial study, we evaluated whether or not the combination of indomethacin and epinephrine in comparison to the single administration of indomethacin differs in the pathogenesis and prevention of post-ERCP pancreatitis. Patients and Methods: One hundred and ninety-two patients were randomized in a double-blinded manner into 3 groups: the epinephrine group (group A), the indomethacin group (group B), and the combined epinephrine and indomethacin group (group C). After the procedure, patients were evaluated for the PEP development. Results: During the procedure, 66 patients were randomized to the epinephrine group (group A), 68 cases to the indomethacin group (group B), and 58 individuals to the indomethacin-epinephrine group (group C). The mean age of patients in the epinephrine group was 59.59 ± 15.680 years, in the indomethacin group it was 58.06 ± 17.125 years, and in the combination group it was 59.62 ± 15.369 years. In the present study, we did not observe a significant difference between the 3 groups in sex, age, pre-ERCP amylase, lipase, and patient and procedure risk factors including pancreatic duct (PD) dilation (p = 0.404), PD cannulation (p = 0.329), and difficult cannulation (p = 0.076) among others. PEP developed in 7 of the 192 individuals (3.6%), 6 PEP cases occurred in the indomethacin group and 1 in the epinephrine group (p = 0.016). Univariate analysis of risk factors for PEP in patients with and without pancreatitis revealed no significant difference between the pancreatitis group and the non-pancreatitis group. Conclusion: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.

scholarly journals Training of Resident Ophthalmologists in Cataract Surgery: A Comparative Study of Two Approaches

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Argyrios Tzamalis ◽  
Lampros Lamprogiannis ◽  
Nikolaos Chalvatzis ◽  
Chrysanthos Symeonidis ◽  
Stavros Dimitrakos ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Intraoperative Complications ◽  
Statistical Significance ◽  
Step Method ◽  
Significant Difference ◽  
Group A ◽  
One Step ◽  
The One ◽  
Group B ◽  
Complications Rate

Purpose.To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery.Methods.502 eyes of 467 patients who underwent resident-performed phacoemulsification were included in the study by reviewing their medical records. Residents were allocated into two groups according to the method applied during their training in cataract surgery; Group A included residents that were trained with the “step-by-step” method and Group B those trained with the “one-step” method. Primary outcome was the incidence of main complications, defined as posterior capsular ruptures and/or zonular dehiscence with vitreous loss.Results.Each resident performed a median of 63 phacoemulsification surgeries. A statistically significant difference (p=0.0032) was noted in the main complications rate between the two groups, yielding a mean of 17.3% in Group A and 7.25% in Group B. Other intraoperative complications were not shown to differ statistically significantly between study groups (p>0.05). Among the first 40 surgeries of each resident, main complications rate differed also statistically significantly (p=0.0048) between Group A (21.67%) and Group B (8.5%), while a better surgical performance-yielding statistical significance in Group A (p=0.017) was indicated in both groups between the 20th and the 30th procedure.Conclusions.Training in cataract surgery using the “one-step” method may lead to an improvement in surgical competency, when measured by complications rates and, therefore, to significantly better quality of training for resident ophthalmologists.

scholarly journals Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

2017 ◽  
Vol 6 (10) ◽  
pp. 2522
Author(s):  
Ritu Bala ◽  
Harminder Singh ◽  
. Rupali ◽  
Kuhu Verma
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
P Value ◽  
Biochemical Tests ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Hypertension is the most prevalent cardiovascular disease and the relevant data suggest that the burden, risk factors and co-morbidities associated with the essential hypertension is increasing with every passing day. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. Aim: The aim of the study was to compare effects of cilnidipine and amlodipine on the blood pressure (BP), heart rate and proteinuria among patients of hypertension with chronic kidney disease.Methods: 100 patients were included in this study. Patients were randomly assigned into two groups Group A and Group B (50 each). Group A: Patients received Cilnidipine (5-10mg/day). Group B: Patients received amlodipine (5-10mg/day).Results: No significant difference in SBP, DBP, MBP and proteinuria while comparing both the groups of patients taking cilnidipine and amlodipine at baseline i.e. 0 to 12 week, 12 to 24 weeks and 0 to 24 weeks. Cilnidipine caused decrease in HR 0 to 12 week (p value 0.001), 12 to 24 weeks (p value 0.001) and 0 to 24 weeks (p value 0.0001). Amlodipine had increased heart rate from baseline to 12 weeks (p value 0.0001), 12 to 24 weeks (p value 0.051) and 0 to 24 weeks (p value 0.001). No significant difference was seen in any biochemical readings.Conclusions: There was a significant change in all the parameters including BP, heart rate, proteinuria and other biochemical tests when they compared within the group but no significant difference while comparing both the groups.

scholarly journals Multivariate analysis of pedicle screw invasion of the proximal facet joint after lumbar surgery

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Peng Tao Wang ◽  
Jia Nan Zhang ◽  
Tuan Jiang Liu ◽  
Jun Song Yang ◽  
Ding Jun Hao
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Joint Angle ◽  
Facet Joint ◽  
Lumbar Surgery ◽  
Lower Lumbar Spine ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lower Lumbar ◽  
Lumbar Spondylolisthesis

Abstract Background To analyze the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. Methods From January 2019 to January 2021, 1794 patients with lumbar degenerative disease, such as lumbar disc herniation, lumbar spinal stenosis and lumbar spondylolisthesis, were treated at our hospital. In all, 1221 cases were included. General data (sex, age, BMI), bone mineral density, proximal facet joint angle, degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment in the two groups were recorded. After the operation, vertebral CT of the corresponding surgical segments was performed for three-dimensional reconstruction and evaluation of whether the vertebral arch root screw interfered with the proximal facet joint. The included cases were divided into an invasion group and a noninvasion group. Univariate analysis was used to screen the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery, and the selected risk factors were included in the logistic model for multivariate analysis. Results The single-factor analysis showed a significant difference in age, BMI, proximal facet joint angle, degenerative lumbar spondylolisthesis, and fixed segment (P < 0.1). Multifactor analysis of the logistic model showed a significant difference for age ≥ 50 years (P < 0.001, OR = 2.291), BMI > 28 kg/m2 (P < 0.001, OR = 2.548), degenerative lumbar spondylolisthesis (P < 0.001, OR = 2.187), gorge cleft lumbar relaxation (P < 0.001, OR = 2.410), proximal facet joint angle (35 ~ 45°: P < 0.001, OR = 3.151; > 45°: P < 0.001, OR = 3.578), and fixed segment (lower lumbar spine: P < 0.001, OR = 2.912). Conclusion Age (≥ 50 years old), BMI (> 28 kg/m2), proximal facet joint angle (35 ~ 45°, > 45°), degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment (lower lumbar spine) are independent risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. Compared with degenerative lumbar spondylolisthesis, facet joint intrusion is more likely in isthmic lumbar spondylolisthesis.

Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications

2021 ◽  
pp. 20201208
Author(s):  
Weitao Ye ◽  
Chenyu Dong ◽  
Churong Lin ◽  
Qidi Wu ◽  
Jiao Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracoscopic Surgery ◽  
Insertion Depth ◽  
Ct Guided ◽  
Pleural Surface ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Medical Adhesive ◽  
Video Assisted Thoracoscopic Surgery

Objective: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. Methods: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. Results: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (β = 1.12, p = 0.018), total insertion depth (β = −0.41, p = 0.013), pleura-needle angle (β = −0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (β = −0.96, p = 0.030) were independently associated with pneumothorax, while age (β = −0.94, p = 0.018), tumor size (β = 0.29, p = 0.007) and its distance from the pleural surface (β = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. Conclusion: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. Advances in knowledge: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.

scholarly journals Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes

2021 ◽  
Vol 14 (11) ◽  
pp. 1735-1740
Author(s):  
Ling Bai ◽  
◽  
Farheen Tariq ◽  
Yu-Ping Zheng ◽  
Hai-Xiao Feng ◽  
...  
Keyword(s):  
Loss Rate ◽  
Dissipated Energy ◽  
Significant Difference ◽  
Single Centre Study ◽  
Group A ◽  
Cumulative Dissipated Energy ◽  
Pars Plana ◽  
Group B ◽  
Complications Rate ◽  
Surgery Duration

AIM: To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes. METHODS: A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (SynergetiesTM) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures. RESULTS: With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P<0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, P<0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, P<0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups. CONCLUSION: Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.

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