scholarly journals Risk Factors for Typical Endometrial Polypoid Adenomyoma

2021 ◽  
Author(s):  
Xinmei Wang ◽  
Hongyuan Zhang ◽  
Juan Xu ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
Menopausal Status ◽  
Uterine Cavity ◽  
Conservative Surgery ◽  
Cervical Canal ◽  
Rare Type ◽  
Normal Endometrium ◽  
Pathologic Features ◽  
Significant Difference ◽  
Independent Risk Factors

Abstract Objective: Typical endometrial polypoid adenomyoma (TPA) is a rare type of lesion in the uterine cavity or cervical canal. Although the clinical and pathologic features of TPA have been described extensively, reports on its pathogenesis and treatment remain inconclusive. This study was conducted to investigate the risk factors for endometrial TPA and recurrence and to further define the pathogenesis and treatment.Study design: This was a retrospective analysis of 488 cases of TPA and 500 cases of normal endometrium. Age, menopausal status, body mass index (BMI), reproductive history, and method of surgery were retrospectively analyzed. Among TPA cases, 360 were treated by conservative surgery. Risk factors for TPA and recurrence were assessed.Results: There was a significant difference in age, menopausal status, BMI, gravidity, and parity between the two groups (P<0.05). Age >50 years, menopause, obesity, gravidity >3, and parity >2 were risk factors for TPA (P<0.05). The incidence rate of endometriosis and adenomyosis in the TPA group was significantly higher than that in the normal endometrium group (P<0.05). Follow-up data (22–77 months) were obtained for 360 patients, revealing gravidity >3, menopause, curettage, and polyp clamp as independent risk factors for the recurrence of TPA (P<0.05). Conclusions: In addition to high estrogen levels, endometrial injury was the main contributor to TPA pathogenesis. Hysteroscopic electrotomy was the preferential treatment for TPA to avoid recurrence, especially for women with risk factors. Increasing the depth of ablation may prevent the recurrence of TPA more efficiently.

scholarly journals Risk Factors for Typical Endometrial Polypoid Adenomyoma

2021 ◽  
Author(s):  
Xinmei Wang ◽  
Hongyuan Zhang ◽  
Juan Xu ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
Menopausal Status ◽  
Uterine Cavity ◽  
Conservative Surgery ◽  
Cervical Canal ◽  
Rare Type ◽  
Normal Endometrium ◽  
Pathologic Features ◽  
Significant Difference ◽  
Independent Risk Factors

Abstract Objective: Typical endometrial polypoid adenomyoma (TPA) is a rare type of lesion in the uterine cavity or cervical canal. Although the clinical and pathologic features of TPA have been described extensively, reports on its pathogenesis and treatment remain inconclusive. This study was conducted to investigate the risk factors for endometrial TPA and recurrence and to further define the pathogenesis and treatment.Study design: This was a retrospective analysis of 488 cases of TPA and 500 cases of normal endometrium. Age, menopausal status, body mass index (BMI), reproductive history, and method of surgery were retrospectively analyzed. Among TPA cases, 360 were treated by conservative surgery. Risk factors for TPA and recurrence were assessed.Results: There was a significant difference in age, menopausal status, BMI, gravidity, and parity between the two groups (P<0.05). Age >50 years, menopause, obesity, gravidity >3, and parity >2 were risk factors for TPA (P<0.05). The incidence rate of endometriosis and adenomyosis in the TPA group was significantly higher than that in the normal endometrium group (P<0.05). Follow-up data (22–77 months) were obtained for 360 patients, revealing gravidity >3, menopause, curettage, and polyp clamp as independent risk factors for the recurrence of TPA (P<0.05). Conclusions: In addition to high estrogen levels, endometrial injury was the main contributor to TPA pathogenesis. Hysteroscopic electrotomy was the preferential treatment for TPA to avoid recurrence, especially for women with risk factors. Increasing the depth of ablation may prevent the recurrence of TPA more efficiently.

scholarly journals Helicobacter pylori Recurrence after Eradication Therapy in Jiangjin District, Chongqing, China

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Gang Zhou
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Recurrence Rate ◽  
Standard Therapy ◽  
Family Members ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Eating Out ◽  
H Pylori ◽  
Infection Recurrence

Purpose. To investigate the recurrence rate of Helicobacter pylori infection after eradication in Jiangjin District, Chongqing, China, and to analyze the related causes. Methods. Outpatients who were eradicated of H. pylori infection with standard therapy between August 2014 and August 2017 were included in this study. The recurrence rate was investigated 1 year later. Data regarding gender, smoking, alcohol intake, frequency of eating out, and treatment strategy were recorded, and their relationships with the recurrence rate were analyzed. Multivariate logistic regression analysis was performed to determine the independent risk factors for H. pylori infection recurrence. Results. In total, 400 patients (225 males and 175 females) were included in this study. Of them, the recurrence rate of H. pylori infection was 4.75% (19/400), with 5.33% (12/225) in males and 4.57% (7/175) in females, showing no gender difference. The recurrence rate was 7.03% (9/128) in smokers and 3.68% (10/272) in nonsmokers, while it was 6.45% (12/186) in those who drink alcohol and 3.27% (7/214) in those who do not drink alcohol, showing no significant differences. The higher the frequency of eating out, the higher the recurrence rate of H. pylori infection (P=0.001). There was a statistically significant difference in the recurrence rate between patients receiving treatment alone and patients whose family members also received treatment (6.08% vs. 0.96%, P=0.035). Drinking and dining out were independent risk factors for H. pylori infection recurrence (P=0.014 for drinkers and P=0.015 and P=0.003 for those who sometimes and often dine out, respectively). Conclusions. The overall recurrence rate after H. pylori eradication by standard therapy in Jiangjin District is 4.75%. Reducing the frequency of eating out and family members receiving treatment may reduce the recurrence of H. pylori infection.

scholarly journals Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

2021 ◽  
Author(s):  
Hui Wang ◽  
Tun Wang ◽  
Hao He ◽  
Xin Li ◽  
Yuan Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Aortic Pseudoaneurysm ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
The Mean

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.

scholarly journals The Crazy-paving Pattern in Chest CT of Coronavirus Disease 2019 Patients; an Alarming Sign for Hospitalization 

2020 ◽  
Author(s):  
Mehdi Gholamzadeh Baeis ◽  
Abolfazl Mozafari ◽  
Fatemeh Movaseghi ◽  
Mehdi Yadollahzadeh ◽  
Ahmad Sohrabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Public Hospital ◽  
Human Beings ◽  
Epidemiological Features ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
The Mean ◽  
Bilateral Lung

Abstract Background: The outbreak of coronavirus disease 2019 (COVID-19) becomes an enormous threat to all human beings. Via this retrospective study conducted on medical records of confirmed COVID-19 pneumonia patients on admission, we investigate the CT manifestation and clinical and laboratory risk factors associated with progression to severe COVID-19 pneumonia and assessed the association among clinical and laboratory records, CT findings, and epidemiological features. The medical records and radiological CT Features of 236 confirmed COVID-19 patients were reviewed at one public hospital and one respiratory clinic in Quom, from 1 August to 30 September 2020. Results: Among a total of 236 confirmed Covid-19 cases, 62 were infected with moderate to severe COVID-19 disease and required hospital admission, and 174 were followed up on outpatient bases. A significant difference was verified in the mean age between outpatients and hospitalized groups. The incidences of bilateral lung involvement, consolidation, linear opacities, crazy-paving pattern, air bronchogram sign, and the number of lobe involvement were significantly higher in hospitalized groups. However, only the crazy-paving pattern was significantly associated with an SpO2 level lower than 90%, with clinical sign of cough severity. Our data indicate that this pattern is also significantly associated with inflammatory levels and the presence of this pattern along with SpO2 level lower than 90%, older age, diabetes, on admission are independent risk factors for COVID-19 progression to severe level.Conclusions: The crazy-paving pattern can predict the severity of COVID-19, which is of great significance for the management and follow-up of COVID-19 pneumonia patients. The clinical factors of aging, male gender, and diabetes, may be risk factors for the crazy-paving pattern, whereas severe coughing is considered to be the most important clinical symptom related to this pattern, and SpO2 level lower than 90%, which is a matter of more severity.

Oral cavity squamous cell carcinoma in the elderly: A retrospective study in 129 patients over 11 years (2000-2010).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17023-e17023
Author(s):  
Laetitia Gambotti ◽  
Emilie Schwob ◽  
Patrick Goudot ◽  
Chloë Bertolus
Keyword(s):  
Risk Factors ◽  
Oral Cavity ◽  
Squamous Cell ◽  
Cox Model ◽  
Alcohol Intoxication ◽  
Tnm Classification ◽  
Operative Complication ◽  
Patient Profile ◽  
Significant Difference ◽  
Independent Risk Factors

e17023 Background: There is no consensus for the management of elderly patients with oral cavity squamous cell carcinomas (OC SCC). Surgeons have to estimate for each patient the benefit or the risk of aggressive treatments in this population. We report the experience of one French university hospital center in the treatment of OC SCC in patients aged > = 70 years. Methods: One hundred and twenty nine patients aged > = 70 years with a primary OC SCC diagnosed between 2000 and 2010 were included retrospectively. Independent risk factors of post-operative complication were identified using a logistic regression. Overall survival (OS) was estimated with Kaplan Meier method. Independent factors of survival were calculated using a Cox model. Results: Mean age was 78 (+/-6), sex ratio was 1.2. Women presented significantly more precancerous lesions (36% vs 21%, p=0.04), less alcohol intoxication (13% vs 59%, p<0.001) and less tobacco consumption (41% vs 81%, p<0.001). Half of the sample was stage T4 of TNM classification. Eighty eight percent of the patients received a curative treatment, including surgery for 101 patients. Among them, the surgical treatment was considered as “standard” (vs “substandard”) for 70%. Thirty percent of the surgical patients presented a post-operative complication. Independent risk factors of complications were T3/T4 stage (OR 4.5 [1.3-15.1]) N+ (vs N0 of TNM classification) (OR 7.3 [2.2-24.0]) and alcohol intoxication (OR 3.6 [1.1-11.4]). The median OS was 13.6 months (43.8 months for T1). There was no significant difference of OS between standard or substandard treatment groups. The independent negative prognostic factors for OS were age > 79 years (HR 1.8 [1.2-2.7]), N+ (HR 1.9 [1.3-2.9]) and ASA score 3/4 (HR 1.8 [1.1-2.9]). Conclusions: In our experience, surgeons probably made the good choice between standard or substandard treatment according to the patient profile but this choice must be oriented by professional guidelines.

Risk Factors for Candidemia in Pediatric Oncology Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4735-4735 ◽  
Author(s):  
Theoklis E Zaoutis ◽  
Priya A Prasad ◽  
A. Russell Localio ◽  
Anne Reilly ◽  
Louis M Bell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Oncology ◽  
Research Funding ◽  
Incidence Density ◽  
Candida Spp ◽  
Oncology Patients ◽  
Targeted Interventions ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Oncology Unit

Abstract Abstract 4735 Background Candida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality, particularly in oncology patients. Few studies have identified the risk factors for candidemia in pediatric oncology patients. Methods We conducted a nested case-control study within a cohort of pediatric patients admitted to the oncology unit at a children's hospital between 2001 and 2004. A case was defined as a patient with a positive blood culture for Candida spp. As time at risk is an important confounding variable in nosocomial studies assessing antibiotic risk factors, we selected two controls per case based on incidence-density sampling. Demographic and clinical data were collected by medical record review. Assessment of exposures was focused on the 2 weeks prior to the development of infection (case)/study entry (control). Conditional multivariate analyses were performed to determine independent risk factors for candidemia. Results We identified 45 oncology patients with candidemia during the study period. The most commonly isolated species were C. albicans (49%), C. parapsilosis (18%), C. glabrata (9%), and C. lusitaniae (9%). The median age of cases was 6.2 years (Interquartile Range (IQR): 2.9– 13.8 years). Median time to candidemia was 12 days (IQR: 4-22 days). There was no significant difference in mortality between cases (7%) and controls (7%). Independent risk factors for candidemia included receipt of aminoglycosides for >3 days (OR: 10.51, CI: 2.96, 64.43), receipt of total parenteral nutrition (OR: 13.82, CI: 2.48, 44.49), and Graft versus Host Disease (GVHD) (OR: 15.09, CI: 0.91, 250.24). Conclusion The receipt of aminoglycosides for >3 days, use of TPN, and GVHD were independently associated with candidemia in pediatric oncology patients. These results may inform targeted interventions to reduce the risk of candidemia in pediatric oncology patients. Disclosures: Zaoutis: Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.

scholarly journals CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

2021 ◽  
pp. 30-38
Author(s):  
A. V. KAMINSKYI ◽  
O. I. ZHDANOVYCH ◽  
T. V. KOLOMIICHENKO ◽  
R. I. ISMAILOV ◽  
S. M. YANUTA
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Retrospective Analysis ◽  
High Frequency ◽  
Premature Birth ◽  
Uterine Cavity ◽  
Lower Percentage ◽  
Control Group ◽  
Cervical Canal ◽  
Cervical Insufficiency

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

scholarly journals Transcranial Sonography with Clinical and Demographic Characteristics to Predict Cognitive Impairment in PD: A Longitudinal Study

2021 ◽  
Author(s):  
Zhiguang Chen ◽  
Wei Zhang ◽  
Wen He ◽  
Yang Guang ◽  
Tengfei Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Sexual Dysfunction ◽  
Age Of Onset ◽  
Transcranial Sonography ◽  
Demographic Characteristics ◽  
Olfactory Dysfunction ◽  
Motor Symptoms ◽  
Significant Difference ◽  
Independent Risk Factors

Abstract Background Parkinson’s disease (PD) is a neurodegenerative disease second only to Alzheimer’s disease and is clinically characterized by a series of motor and non-motor symptoms. The latter often appear before motor symptoms, while cognitive impairment mostly occurs within a few years after the diagnosis of PD. We Aimed to predict the risk factors of cognitive impairment in PD patients based on transcranial sonography, clinical symptoms, and demographic characteristics. Independent-sample t-test was used for continuous data, and chi-square test was used for countable data. According to the occurrence time of cognitive impairment (CI), 172 PD patients were divided into non-CI (N-CI, n=48), CI at the first treatment (F-CI, n=58), and CI at the last treatment (L-CI, n=66). The age of onset, first treatment and smoking history of CI patients were significantly different from those with N-CI. When age of first treatment ≥61 years was considered the boundary value to diagnose CI, the sensitivity and specificity were 77.40% and 66.70%, respectively. At the first treatment, there was significant difference in depression between F-CI and N-CI. At the last treatment, the cumulative and new or aggravated hypomnesia of L-CI was significantly more than that of N-CI. There was significant difference in TCS grading between the first- and last treatment in L-CI. Depression, sexual dysfunction, and olfactory dysfunction were independent risk factors for CI during the last treatment, while memory impairment was an independent risk factor for CI during the entire treatment. The sensitivity and specificity of predicting CI in PD patients were 81.80% and 64.60%, respectively. The older the age of onset and treatment of PD patients, the more likely they were to have CI. Hypomnesia, depression, sexual dysfunction, and olfactory dysfunction can be used as independent risk factors to predict CI in PD patients.

scholarly journals Nomograms Combining Ultrasonic Features With Clinical and Pathological Features for Estimation of Delphian Lymph Node Metastasis Risk in Papillary Thyroid Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Qi Qi ◽  
Pan Xu ◽  
Cheng Zhang ◽  
Suping Guo ◽  
Xingzhi Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Clinical Pathology ◽  
Diagnostic Model ◽  
Pathological Features ◽  
Node Metastasis ◽  
Significant Difference ◽  
Independent Risk Factors

BackgroundThis work explores the clinical significance of Delphian lymph nodes (DLN) in thyroid papillary carcinoma (PTC). At the same time, a nomogram is constructed based on clinical, pathological, and ultrasonic (US) features to evaluate the possibility of DLN metastasis (DLNM) in PTC patients. This is the first study to predict DLNM using US characteristics.MethodsA total of 485 patients, surgically diagnosed with PTC between February 2017 and June 2021, all of whom underwent thyroidectomy, were included in the study. Using the clinical, pathological, and US information of patients, the related factors of DLNM were retrospectively analyzed. The risk factors associated with DLNM were identified through univariate and multivariate analyses. According to clinical + pathology, clinical + US, and clinical + US + pathology, the predictive nomogram for DLNM was established and validated.ResultsOf the 485 patients with DLN, 98 (20.2%) exhibited DLNM. The DLNM positive group had higher positive rates of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and T3b–T4b thyroid tumors than the negative rates. The number of CLNM and LLNM lymph nodes in the DLNM+ group was higher as compared to that in the DLNM- group. Multivariate analysis demonstrated that the common independent risk factors of the three prediction models were male, bilaterality, and located in the isthmus. Age ≥45 years, located in the lower pole, and nodural goiter were protective factors. In addition, the independent risk factors were classified as follows: (I) P-extrathyroidal extension (ETE) and CLNM based on clinical + pathological characteristics; (II) US-ETE and US-CLNM based on clinical + US characteristics; and (III) US-ETE and CLNM based on clinical +US + pathological features. Better diagnostic efficacy was reported with clinical + pathology + US diagnostic model than that of clinical + pathology diagnostic model (AUC 0.872 vs. 0.821, p = 0.039). However, there was no significant difference between clinical + pathology + US diagnostic model and clinical + US diagnostic model (AUC 0.872 vs. 0.821, p = 0.724).ConclusionsThis study found that DLNM may be a sign that PTC is more invasive and has extensive lymph node metastasis. By exploring the clinical, pathology, and US characteristics of PTC progression to DLNM, three prediction nomograms, established according to different combinations of features, can be used in different situations to evaluate the transfer risk of DLN.

Risk factors for intraoperative lateral mass fracture of lateral mass screw fixation in the subaxial cervical spine

2014 ◽  
Vol 20 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Shinichi Inoue ◽  
Tokuhide Moriyama ◽  
Toshiya Tachibana ◽  
Fumiaki Okada ◽  
Keishi Maruo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Screw Insertion ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Lateral Mass Fracture ◽  
Destructive Spondyloarthropathy

ObjectAlthough lateral mass screw fixation for the cervical spine is a safe technique, lateral mass fracture during screw fixation is occasionally encountered intraoperatively. This event is regarded as a minor complication; however, it poses difficulties in management that may affect fixation stability and clinical outcome. The purpose of this study is to determine the incidence and etiology of lateral mass fractures during cervical lateral mass screw fixation.MethodsA retrospective clinical review of patient records was performed in 117 consecutive patients (mean age 57 years, range 15–86 years) who underwent lateral mass screw fixation using a modified Magerl method from 1997 to 2010 at a single institution. A total of 555 lateral masses were included in this study. The outer diameters of the screws were 3.5 or 4.0 mm. In the retrospective clinical analysis, the incidence of intraoperative lateral mass fractures was reviewed. Potential risk factors for this complication were assessed using multivariate analysis.ResultsThe incidence of lateral mass fractures during cervical lateral mass screw fixation was 4.7% (26 lateral masses) among all cases. Among the disorders, the incidence was highest in patients with destructive spondyloarthropathy (DSA) (18.8%, 12 lateral masses). There was no significant difference with respect to lateral mass fracture between the use of 4.0-mm screws (5.6%) and 3.5-mm screws (3.6%). Independent risk factors identified by logistic regression were DSA (OR 7.89, p < 0.001) and screw insertion in the C-6 lateral masses (OR 2.80, p = 0.018).ConclusionsThe overall incidence of lateral mass fracture during cervical lateral mass screw fixation was 4.7%. Destructive spondyloarthropathy as an underlying cause of morbidity and screw placement in the C-6 lateral mass were identified as independent risk factors. Use of a 4.0-mm screw in patients with DSA may be a principal risk factor for this complication.

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