scholarly journals The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

2013 ◽  
Vol 19 (5) ◽  
pp. 555-563 ◽  
Author(s):  
Zoher Ghogawala ◽  
Christopher I. Shaffrey ◽  
Anthony L. Asher ◽  
Robert F. Heary ◽  
Tanya Logvinenko ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Patient Reported Outcome ◽  
Lumbar Discectomy ◽  
Cooperative Research ◽  
Single Level ◽  
Sf 36 ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Level Fusion

Object There is significant practice variation and considerable uncertainty among payers and other major stakeholders as to whether many surgical treatments are effective in actual US spine practice. The aim of this study was to establish a multicenter cooperative research group and demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures using prospectively collected patient-reported outcome measures. Methods An observational prospective cohort study was conducted at 13 US academic and community sites. Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis were included. Patients completed the 36-item Short-Form Survey Instrument (SF-36), Oswestry Disability Index (ODI), and visual analog scale (VAS) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: 125 patients with lumbar disc herniation, and 35 with lumbar spondylolisthesis. All patient data were entered into a secure Internet-based data management platform. Results Of 249 patients screened, there were 198 enrolled over 1 year. The median age of the patients was 45.0 years (49% female) for lumbar discectomy (n = 148), and 58.0 years (58% female) for lumbar spondylolisthesis (n = 50). At 30 days, 12 complications (6.1% of study population) were identified. Ten patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis required reoperation. The overall follow-up rate for the collection of patient-reported outcome data over 1 year was 88.3%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, VAS, and SF-36 scores (p ≤ 0.0002), which persisted over the 1-year follow-up period (p < 0.0001). By the 1-year follow-up evaluation, more than 80% of patients in each cohort who were working preoperatively had returned to work. Conclusions It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice. Clinical trial registration no.: 01220921 (ClinicalTrials.gov).

scholarly journals Cost-effectiveness of lumbar discectomy and single-level fusion for spondylolisthesis: experience with the NeuroPoint-SD registry

2014 ◽  
Vol 36 (6) ◽  
pp. E3 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Robert G. Whitmore ◽  
Jill N. Curran ◽  
John E. Ziewacz ◽  
Rishi Wadhwa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Single Level ◽  
Sf 36 ◽  
Repeat Operation ◽  
Lumbar Spinal ◽  
Lumbar Spondylolisthesis ◽  
Level Fusion

Object There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes. Methods An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level fusion for spondylolisthesis or single-level lumbar discectomy were included. The 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: lumbar disc (125 patients) and lumbar listhesis (35 patients). The quality-adjusted life year (QALY) data were calculated using 6-dimension utility index scores. Direct costs and complication costs were estimated using Medicare reimbursement values from 2011, and indirect costs were estimated using the human capital approach with the 2011 US national wage index. Total costs equaled $14,980 for lumbar discectomy and $43,852 for surgery for lumbar spondylolisthesis. Results There were 198 patients enrolled over 1 year. The mean age was 46 years (49% female) for lumbar discectomy (n = 148) and 58.1 years (60% female) for lumbar spondylolisthesis (n = 50). Ten patients with disc herniation (6.8%) and 1 with listhesis (2%) required repeat operation at 1 year. The overall 1-year follow-up rate was 88%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, visual analog scale, and SF-36 scores (p = 0.0002), which persisted at the 1-year evaluation (p < 0.0001). By 1 year, more than 80% of patients in each cohort who were working preoperatively had returned to work. Lumbar discectomy was associated with a gain of 0.225 QALYs over the 1-year study period ($66,578/QALY gained). Lumbar spinal fusion for Grade I listhesis was associated with a gain of 0.195 QALYs over the 1-year study period ($224,420/QALY gained). Conclusions This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. These data are useful for demonstrating return to work and cost-effectiveness following surgical treatment of single-level lumbar disc herniation or spondylolisthesis. One-year cost per QALY was obtained, and this cost per QALY is expected to improve further by 2 years. This work sets the stage for real-world analysis of the value of health interventions.

Patient-reported outcome measures after surgery for an acetabular fracture

2018 ◽  
Vol 100-B (5) ◽  
pp. 640-645 ◽  
Author(s):  
B. Frietman ◽  
J. Biert ◽  
M. J. R. Edwards
Keyword(s):  
Outcome Measures ◽  
Hip Joint ◽  
Acetabular Fracture ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ct Scans ◽  
Sf 36 ◽  
Patient Reported ◽  
Post Traumatic

Aims The aim of this study was to record the incidence of post-traumatic osteoarthritis (OA), the need for total hip arthroplasty (THA), and patient-reported outcome measures (PROMS) after surgery for a fracture of the acetabulum, in our centre. Patients and Methods All patients who underwent surgery for an acetabular fracture between 2004 and 2014 were included. Patients completed the 36-Item Short Form Health Survey (SF-36) and the modified Harris Hip Score (mHHS) questionnaires. A retrospective chart and radiographic review was performed on all patients. CT scans were used to assess the classification of the fracture and the quality of reduction. Results A total of 220 patients were included, of which 55 (25%) developed post-traumatic OA and 33 (15%) underwent THA. A total of 164 patients completed both questionnaires. At a mean follow-up of six years (2 to 10), the mean SF-36 score for patients with a preserved hip joint was higher on role limitations due to physical health problems than for those with OA or those who underwent THA. In the dimension of bodily pain, patients with OA had a significantly better score than those who underwent THA. Patients with a preserved hip joint had a significantly better score on the function scale of the mHHS and a better total score than those with OA or who underwent THA. Conclusion Of the patients who were treated surgically for an acetabular fracture (with a mean follow-up of six years), 15% underwent THA at a mean of 2.75 years postoperatively. Patients with a THA had a worse functional outcome than those who retain their native hip joint. We recommend using PROMS and CT scans when reviewing these patients. Cite this article: Bone Joint J 2018;100-B:640–5.

scholarly journals Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Siegmund Lang ◽  
Carsten Neumann ◽  
Christina Schwaiger ◽  
Andreas Voss ◽  
Volker Alt ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Spinal Fractures ◽  
Patient Reported Outcome ◽  
Bony Fusion ◽  
Sf 36 ◽  
Patient Reported ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

scholarly journals Does Dynamic Ventral Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures in Mid-term Follow-up?

2020 ◽  
Author(s):  
Siegmund Lang ◽  
Carsten Neumann ◽  
Lasse Fiedler ◽  
Volker Alt ◽  
Markus Loibl ◽  
...  
Keyword(s):  
Locking Plate ◽  
Sagittal Alignment ◽  
Short Form ◽  
Patient Reported Outcome ◽  
Type B ◽  
Cervical Fractures ◽  
Sf 36 ◽  
Patient Reported ◽  
Bony Consolidation

Abstract BackgroundIt remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with a dynamic plate compared to rigid locking plate system.Patients and MethodsPatients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. Only patients with complete radiological follow (pre- and postoperatively and minimum one year after surgery) were included in the study. Next to the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years the patient reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36) with the physical components summary (PCS) and mental components summary (MCS), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) score.Results33 patients met the in- and exclusion criteria. 26 patients suffered from an AO Type B or C fracture. 13 patients were treated with a dynamic plate and 20 with a rigid locking plate. Both, the sagittal alignment, and the sagittal translation could be sufficiently restored with no differences between the two groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (91%) with no significant differences between both groups (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients PROMs could be evaluated after a mean follow-up of 71.2±25.5 months. No significant differences between DP and RP could be detected in EQ-5D, SF- 36 (PCS and MCS) or NDI (EQ-5D: 72±5; SF-36 PCS 41.9±16.2, MCS 45.4±14.9; NDI: 11±9).ConclusionThe dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered AO Type B and C fractures.

scholarly journals Addition of Fusion to Decompression for Grade I Degenerative Lumbar Spondylolisthesis is Associated With Greater Patient-Reported Outcome Improvements at Twenty-Four-Month Follow-Up: A Multicenter Study Using the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jian Guan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Mohammed A Alvi ◽  
Steven D Glassman ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Primary Outcome Measure ◽  
Patient Reported Outcome ◽  
Leg Pain ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-mo outcomes for patients undergoing decompression alone vs decompression and fusion. METHODS Patients undergoing single-level surgery from 7/1/2014 to 6/30/2016 were identified. The primary outcome measure, 24-mo Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed. RESULTS Of the 608 patients (85.5% with at least 24-mo follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-mo change in ODI was significantly greater in the fusion group than the decompression-only group (−25.8 ± 20.0 vs −15.2 ± 19.8, P < .001). Fusion remained independently associated with 24-mo ODI change in our multivariable model (B = −7.05, 95% CI 10.70-3.39, P = < .001). Patients in the fusion group were significantly more likely to reach minimal clinically important difference (MCID, 12.8 points) in ODI at 24 mo (73.3% vs 56.0%, P = < .001), and to experience significantly greater NRS back pain improvement at 24-mo follow-up (3.8 ± 3.1 vs −1.8 ± 3.9, P < .001). Fusion was also independently associated with achieving MCID for ODI at 24 mo in our logistic regression model (OR 1.767, 95% CI 1.058-2.944, P = .029). CONCLUSION The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 mo. Longer-term follow-up is warranted to assess whether this effect is sustained.

Longitudinal changes in patient-reported outcome measures following total hip arthroplasty and predictors of deterioration during follow-up

2019 ◽  
Vol 101-B (7) ◽  
pp. 768-778 ◽  
Author(s):  
V. P. Galea ◽  
P. Rojanasopondist ◽  
L. H. Ingelsrud ◽  
H. E. Rubash ◽  
C. Bragdon ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Deterioration ◽  
Sf 36 ◽  
Patient Reported ◽  
Clinically Significant ◽  
One Year ◽  
Anxiety Depression

AimsThe primary aim of this study was to quantify the improvement in patient-reported outcome measures (PROMs) following total hip arthroplasty (THA), as well as the extent of any deterioration through the seven-year follow-up. The secondary aim was to identify predictors of PROM improvement and deterioration.Patients and MethodsA total of 976 patients were enrolled into a prospective, international, multicentre study. Patients completed a battery of PROMs prior to THA, at three months post-THA, and at one, three, five, and seven-years post-THA. The Harris Hip Score (HHS), the 36-Item Short-Form Health Survey (SF-36) Physical Component Summary (PCS), the SF-36 Mental Component Summary (MCS), and the EuroQol five-dimension three-level (EQ-5D) index were the primary outcomes. Longitudinal changes in each PROM were investigated by piece-wise linear mixed effects models. Clinically significant deterioration was defined for each patient as a decrease of one half of a standard deviation (group baseline).ResultsImprovements were noted in each PROM between the preoperative and one-year visits, with one-year values exceeding age-matched population norms. Patients with difficulty in self-care experienced less improvement in HHS (odds ratio (OR) 2.2; p = 0.003). Those with anxiety/depression experienced less improvement in PCS (OR -3.3; p = 0.002) and EQ-5D (OR -0.07; p = 0.005). Between one and seven years, obesity was associated with deterioration in HHS (1.5 points/year; p = 0.006), PCS (0.8 points/year; p < 0.001), and EQ-5D (0.02 points/year; p < 0.001). Preoperative difficulty in self-care was associated with deterioration in HHS (2.2 points/year; p < 0.001). Preoperative pain from other joints was associated with deterioration in MCS (0.8 points/year; p < 0.001). All aforementioned factors were associated with clinically significant deterioration in PROMs (p < 0.035), except anxiety/depression with regard to PCS (p = 0.060).ConclusionThe present study finds that patient factors affect the improvement and deterioration in PROMs over the medium term following THA. Special attention should be given to patients with risk factors for decreased PROMs, both preoperatively and during follow-up. Cite this article: Bone Joint J 2019;101-B:768–778.

Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy

2011 ◽  
Vol 14 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Kaisorn L. Chaichana ◽  
Debraj Mukherjee ◽  
Owoicho Adogwa ◽  
Joseph S. Cheng ◽  
Matthew J. McGirt
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Oswestry Disability Index ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Somatic Anxiety ◽  
Single Level ◽  
Sf 36

Object Lumbar discectomy is the most common surgical procedure performed in the US for patients experiencing back and leg pain from herniated lumbar discs. However, not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor clinical outcomes. The goal of this study was therefore to determine the role that preoperative depression and somatic anxiety have on long-term back and leg pain, disability, and quality of life (QOL) for patients undergoing single-level lumbar discectomy. Methods In 67 adults undergoing discectomy for a single-level herniated lumbar disc, the authors determined quantitative measurements of leg and back pain (visual analog scale [VAS]), quality of life (36-Item Short Form Health Survey [SF-36]), and disease-specific disability (Oswestry Disability Index) preoperatively and at 6 weeks, 3, 6, and 12 months after surgery. The degree of preoperative depression and somatization was assessed using the Zung Self-Rating Depression Scale and a modified somatic perception questionnaire (MSPQ). Multivariate regression analyses were performed to assess associations between Zung Scale and MSPQ scores with achievement of a minimum clinical important difference (MCID) in each outcome measure by 12 months postoperatively. Results All patients completed 12 months of follow-up. Overall, a significant improvement in VAS leg pain, VAS back pain, Oswestry Disability Index, and SF-36 Physical Component Summary scores was observed by 6 weeks after surgery. Improvements in all outcomes were maintained throughout the 12-month follow-up period. Increasing preoperative depression (measured using the Zung Scale) was associated with a decreased likelihood of achieving an MCID in disability (p = 0.006) and QOL (p = 0.04) but was not associated with VAS leg pain (p = 0.96) or back pain (p = 0.85) by 12 months. Increasing preoperative somatic anxiety (measured using the MSPQ) was associated with decreased likelihood of achieving an MCID in disability (p = 0.002) and QOL (p = 0.03) but was not associated with leg pain (p = 0.64) or back pain (p = 0.77) by 12 months. Conclusions The Zung Scale and MSPQ are valuable tools for stratifying risk in patients who may not experience clinically relevant improvement in disability and QOL after discectomy. Efforts to address these confounding and underlying contributors of depression and heightened somatic anxiety may improve overall outcomes after lumbar discectomy.

scholarly journals Outcomes of Modified Scarf Osteotomy for Male Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0043
Author(s):  
Daniel J. Scott ◽  
Samuel E. Ford ◽  
Shannon F. Alejandro ◽  
David K. Myer ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Techniques ◽  
Patient Reported Outcome ◽  
Metatarsal Osteotomy ◽  
Historical Comparison ◽  
Scarf Osteotomy ◽  
Sf 36 ◽  
Patient Reported ◽  
Vas Scores

Category: Bunion Introduction/Purpose: Compared to women, hallux valgus in men is less common, more severe, and has higher rates of undercorrection, recurrence and greater distal metatarsal articular angle (DMAA). Bunionectomies that correct metatarsus primus varus (MPV) by valgus rotation paradoxically increase 1stMTP valgus in high DMAA, contributing to recurrence and undercorrection. While proximal valgus osteotomy or arthrodesis plus distal varus-producing metatarsal osteotomy can correct both components, there is a simpler solution. A modified Scarf osteotomy technique was developed in which the osteotomy is simultaneously translated laterally to correct MPV, while rotating the distal metatarsal in varus to correct DMAA. While previous literature on male hallux valgus is comprised of many studies using a combination of surgical techniques, all patients in this series had the same procedure. Methods: A retrospective review of prospectively collected data was performed in male patients treated with modified scarf osteotomy and soft tissue realignment for symptomatic hallux valgus, who failed conservative treatment. Preop and postop range of motion (ROM), radiographs, and validated patient reported outcome (PROM) scores including Pain VAS and SF-36, were tabulated, as well as complications, and AOFAS Hallux scores for historical comparison. There were 22 patients (26 feet), mean age 53 (17-79). Mean clinical and radiographic follow up was 24 months, and mean postop PROM’s follow up was 4.7 years. Six of 26 feet (23%) required a modified Akin osteotomy for a congruent 1stMTP joint. A subset of patients with minimum 4-year and mean 7.6 -year follow up (9 patients, 10 feet), was also analyzed. Weightbearing radiographs were evaluated for DMAA, hallux valgus angle (HVA) and 1st-2ndintermetatarsal angles (IMA). Results: Statistically significant improvements were found in VAS scores (5.8 to 1, p<0.001); SF-36 physical (44 to 56.7, p<0.001); IMA (15.9 to 8.7, p<0.001), HVA (36.1 to 15.1, p<0.001), DMAA (12.7 to 6.9, p=0.01) and AOFAS scores (44 to 79, p<0.001). Total 1stMTP ROM decreased from 60.9 to 50.8 degrees (p=0.06). One patient had delayed wound healing requiring oral antibiotics and wound vacuum application. Statistically significant improvements were maintained over time in the 7.6-year follow up sub-group, with VAS scores 6.2 to 1.3 (p<0.001), SF-36 physical from 40.8 to 61.3 (p=0.008), and SF-36 mental from 55.7 to 62.3 (p=0.002). Conclusion: This study found statistically significant improvements in both subjective validated PROM’s and objective radiographic measures using a special modification of the scarf osteotomy to address the characteristic increased DMAA that underlies complications and under correction previously reported in male hallux valgus. The corrections were well maintained at long-term follow-up including a robust correction of the DMAA.

Patient-Reported Outcome Measures and Radiological Outcomes in Mobile-Bearing Total Ankle Arthroplasty With Varus or Valgus Deformity

2020 ◽  
pp. 107110072094985
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Mohammad Alkhreisat ◽  
Malik S. Siddique
Keyword(s):  
Physical Health ◽  
Mobile Bearing ◽  
Varus Deformity ◽  
Patient Reported Outcome Measures ◽  
Valgus Deformity ◽  
Patient Reported Outcome ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Patient Reported

Background: There is increasing evidence that varus deformity does not negatively affect total ankle arthroplasty (TAA) outcomes, but there is a sparsity of evidence for valgus deformity. We present our outcomes using a mobile-bearing prosthesis for neutral, varus, and valgus ankles. Methods: This is a retrospective cohort study of consecutive cases identified from a local joint registry. In total, 230 cases were classified based on preoperative radiographs as neutral (152 cases), varus greater than 10 degrees (60 cases), or valgus greater than 10 degrees (18 cases). Tibiotalar angle was again measured postoperatively and at final follow-up (mean follow-up of 55.9 months). A total of 164 cases had adequate patient-reported outcome measures data (Foot and Ankle Outcome Score, Short Form–36 [SF-36] scores, and patient satisfaction) for analysis (mean follow-up of 61.6 months). The groups were similar for body mass index and length of follow-up, but neutral ankles were younger ( P = .021). Results: Baseline scores were equal except SF-36 physical health, with valgus ankles scoring lowest ( P = .045). Valgus ankles had better postoperative pain ( P = .025) and function ( P = .012) than neutral. Pre- to postoperative change did not reach statistical significance except physical health, in which valgus performed best ( P = .039). Mean final angle for all groups was less than 5 degrees. There was no significant difference in revision rates. Conclusion: Our study is consistent with previous evidence that varus deformity does not affect outcome in TAA. In addition, in our cohort, outcomes were satisfactory with valgus alignment. Postoperative coronal radiological alignment was affected by preoperative deformity but within acceptable limits. Coronal plane deformity did not negatively affect radiological or clinical outcomes in TAA. Level of Evidence: Level III, retrospective comparative study.

Cerebral Cavernous Malformations: Patient-Reported Outcome Validates Conservative Management

2017 ◽  
Vol 44 (5-6) ◽  
pp. 313-319 ◽  
Author(s):  
Vitor Chehuen Bicalho ◽  
Anke Bergmann ◽  
Flávio Domingues ◽  
João Thiago Frossard ◽  
Jorge Paes Barreto Marcondes de Souza
Keyword(s):  
Vascular Malformations ◽  
Patient Reported Outcome ◽  
Neurological Deficits ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Familial Form ◽  
Sf 36 ◽  
Patient Reported

Background: Cerebral cavernous malformations (CCM) are clusters of dilated sinusoidal channels lined by a single layer of endothelium. In contradistinction to arteriovenous malformations, these lesions do not have smooth muscle or elastin in their lining and they are angiographically occult, and the MRI is the most sensitive test for CCM detection. CCM are one of the most prevalent vascular malformations of the central nervous system, affecting about 0.4-0.6% of the general population. The main complication of this malformation is the risk of bleeding, which may cause neurological deficits that affect the quality of life (QoL) in patients. When symtomatic, they may be surgically treated for relieving the mass effect and seizures refractory to drug uses, hemorrhage and drug-refractory epilepsy. Patient-reported outcome (PRO) may be a strategy that can be used to evaluate QoL of CCM population and was used in a sample of non-operated patients. Methods: An observational, cross-sectional analysis to evaluate the PRO using the SF-36 and EuroQol 5 dimensions (EQ-5D) questionnaires of QoL added to functional metrics using the Karnofsky Performance Status (KPS) in 49 patients not submitted to intervention and with long-term follow-up. Results: During the 364 person-years of follow-up, there was an average of individual follow-up of 7.42 years. The mean age was 46.8 years (18-84) - 57% of them were female, 71% had superficial lesions, and 65% had the familial form. Comparisons of SF-36 dimensions with KPS graded <100 had a worse score only in terms of the pain (p = 0.04), vitality (p = 0.001), and general state of health (p = 0.03) domains. The domain mental health was worse in patients without surgical indication (p = 0.032). The functional capacity domain had the highest overall grading in the group. The EQ-5D dimensions of mobility (p = 0.03) and pain/discomfort (p = 0.001) were the ones with lower score compared to KPS <100. Conclusion: The study is the first to evaluate, with validated tools, the PRO of non-operated CCM patients and has demonstrated in a selected group of patients that it was possible to achieve long-term clinical stability, thereby maintaining QoL and functional neurological outcome.

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