Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up

OBJECTIVE The authors sought to investigate clinical and radiological outcomes after thoracic posterior fusion surgery during a minimum of 10 years of follow-up, including postoperative progression of ossification, in patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHODS The study participants were 34 consecutive patients (15 men, 19 women) with an average age at surgery of 53.6 years (range 36–80 years) who underwent posterior decompression and fusion surgery with instrumentation at the authors’ hospital. The minimum follow-up period was 10 years. Estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA score recovery rates were investigated. Dekyphotic changes were evaluated on plain radiographs of thoracic kyphotic angles and fusion levels pre- and postoperatively and 10 years after surgery. The distal junctional angle (DJA) was measured preoperatively and at 10 years after surgery to evaluate distal junctional kyphosis (DJK). Ossification progression at distal intervertebrae was investigated on CT. RESULTS The Cobb angles at T1–12 were 46.8°, 38.7°, and 42.6°, and those at the fusion level were 39.6°, 31.1°, and 34.1° pre- and postoperatively and at 10 years after surgery, respectively. The changes in the kyphotic angles from pre- to postoperatively and to 10 years after surgery were 8.0° and 7.2° at T1–12 and 8.4° and 7.9° at the fusion level, respectively. The DJA changed from 4.5° postoperatively to 10.9° at 10 years after surgery. There were 11 patients (32.3%) with DJK during follow-up, including 4 (11.8%) with vertebral compression fractures at lower instrumented vertebrae or adjacent vertebrae. Progression of ossification of the ligamentum flavum (OLF) on the caudal side occurred in 8 cases (23.6%), but none had ossification of the posterior longitudinal ligament (OPLL) progression. Cases with OLF progression had a significantly lower rate of DJK (0% vs 38.5%, p < 0.01), a lower DJA (3.4° vs 13.2°, p < 0.01), and a smaller change in DJA at 10 years after surgery (0.8° vs 8.1°, p < 0.01). CONCLUSIONS Posterior decompression and fusion surgery with instrumentation for T-OPLL was found to be a relatively safe and stable surgical procedure based on the long-term outcomes. Progression of OLF on the caudal side occurred in 23.6% of cases, but cases with OLF progression did not have DJK. Progression of DJK shifts the load in the spinal canal forward and the load on the ligamentum flavum is decreased. This may explain the lack of ossification in cases with DJK.

Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis

Study Design: Retrospective radiological analysis. Objective: To explore whether proximal fusion level above first coronal reverse vertebrae (FCRV) could decrease risk of adjacent segment degeneration (ASD) in degenerative lumbar scoliosis (DLS). Methods: One hundred and 16 DLS patients were divided into 2 groups according to occurrence of ASD: study group (ASD positive group) and control group (ASD negative group). FCRV was defined as the first vertebrae that presents opposite orientation of asymmetric Hounsfield unit (HU) ratio from the other vertebrae within major curve. Incidence of ASD was evaluated in subgroups according to location between FCRV and upper instrumented vertebrae (UIV). Results: The fusion level was shorter in study group than that in control group. There were 12 patients presented FCRV 2-level proximal than SV, 32 patients presented FCRV 1-level proximal than SV, 35 patients presented the same vertebra of FCRV with SV, 23 patients presented FCRV 1-level distal than SV, 14 patients presented FCRV 2-level distal than SV. When UIV located above FCRV, no patient presented ASD, while 15.4% patients presented ASD when UIV located on FCRV. In study group, proximal scoliosis progression was detected in 1 patient (3.9%) when UIV located on FCRV, and 17 patients (29.8%) when UIV located below FCRV. Conclusions: Proximal fusion level above FCRV could decrease the risk of ASD in DLS, especially for the proximal scoliosis progression. FCRV represent the transitional point of the mechanical load on coronal plane, and may be within a more stable condition than stable vertebrae measured from radiographs.

Difusi Kognitif Remaja: Kebutuhan Video Tutorial Latihan Difusi Kognitif

Abstrak Penelitian ini bertujuan untuk mempelajari tingkat fusi kognitif remaja dan alat yang sesuai untuk memfasilitasi latihan difusi kognitif. Convenience sampling digunakan untuk mengumpulkan data dari 199 peserta didik. Instrumen yang digunakan adalah Cognitive Fusion Questionnaire (CFQ-7). Hasil penelitian menunjukkan bahwa 60% remaja mengalami fusi kognitif tinggi (m = 29). Hasil tingkat fusi berdasarkan jenis kelamin, perempuan memiliki tingkat fusi yang lebih tinggi dibandingkan laki-laki (30 vs 28). Persentase perempuan yang mengalami fusi tingkat tinggi melebihi jumlah laki-laki (53% vs 42%). Hasil tingkat fusi berdasarkan sosial ekonomi, tingkat sosial ekonomi rendah memiliki tingkat fusi yang lebih tinggi dibandingkan sosial ekonomi tinggi (34 vs 29). Persentase sosial ekonomi rendah yang mengalami fusi tingkat tinggi melebihi jumlah sosial ekonomi tinggi (75% vs 48%). Sebagian besar peserta didik memiliki eksposur terbatas pada latihan difusi kognitif (-70%) dan semuanya ingin belajar latihan difusi kognitif melalui video. Direkomendasikan bahwa video latihan difusi kognitif dibutuhkan untuk membantu peserta didik dalam meningkatkan kemampuan difusi kognitifnya. Kata Kunci: Difusi Kognitif, Fusi Kognitif Abstract This study aims to explore the level of adolescents’ cognitive fusion and suitable tools to facilitate cognitive defusion exercise. The convenience sampling used to gather the data from 199 students. The instrument used are the Cognitive Fusion Questionnaire (CFQ-7). The results showed that 60% of adolescents experienced high cognitive fusion (m = 29). The result of fusion level based on gender, female has higher level fusion than male (30 vs 28). The percentage of female who experience high level fusion was outnumber male (53% vs 42%). The result of fusion level based on sosial economy, low social economy higher level fusion than high social economy (34 vs 29). The percentage of low social economy who experience high level fusion was outnumber high social economy (75% vs 48%). Most of student has limited exposure to cognitive diffusion exercises (-70%) and all of them eager to learn cognitive defusion exercises through video. It is recommended that cognitive defusion exercise video is needed to help student increase their cognitive defusion skill. Keyword: Cognitive Defusion, Cognitive Fusion

Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion

Objective This study was performed to analyze the correlation between perioperative hidden blood loss (HBL) and the general condition of patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods We retrospectively analyzed patients who underwent TLIF from July 2017 to July 2019 in our hospital. Sex, age, body mass index, underlying diseases, American Society of Anesthesiologists classification, coagulation function, preoperative and postoperative hemoglobin level and hematocrit, surgery time, fusion level, intraoperative blood loss, and drainage volume were recorded. Postoperative complications were also recorded. The amount of HBL was calculated, and its correlation with related variables was analyzed. Results The mean surgery time was 153.32 ± 54.86 minutes. The total perioperative blood loss was 789.22 ± 499.68 mL, including HBL of 315.69 ± 199.87 mL. Pearson correlation analysis showed statistically significant differences in HBL according to the body mass index, hypertension, fibrinogen, surgery time, and fusion level. Multiple linear regression analysis indicated that the surgery time and fusion level were independent risk factors for HBL. Conclusions A certain amount of HBL occurs in TLIF surgery and cannot be ignored in daily clinical work. The operation time and surgery level are independent risk factors for HBL.