Abstract Apathy is the most common neuropsychiatric syndrome in Alzheimer's disease (AD) affecting 19–76% of patients, but is difficult to distinguish from depression, because of the frequent ...comorbidities and a considerable overlap in key symptoms. A structured clinical interview and a specific set of diagnostic criteria to diagnose apathy in dementia have been recently validated, but so far its nosological position is still a debated issue, even if several studies tend to consider apathy a discrete and specific syndrome. The pathopshysiology of apathy in neuropsychiatric disorders is still unknown, however, recent studies suggest that an important role is played by dysfunctions of the frontal lobe and basal ganglia. Both apathy and depression can have a negative impact on the progression of AD, therefore, an accurate differential diagnosis is fundamental to reach an appropriate family education and to obtain a possibly effective treatment.
Purpose
There are reports that performing lateral lumbar interbody fusion (LLIF) in a prone, single position (single-prone LLIF) can be done safely in the prone position because the retroperitoneal ...organs reflect anteriorly with gravity. However, only a few study has investigated the safety of single-prone LLIF and retroperitoneal organ positioning in the prone position. We aimed to investigate the positioning of retroperitoneal organs in the prone position and evaluate the safety of single-prone LLIF surgery.
Methods
A total of 94 patients were retrospectively reviewed. The anatomical positioning of the retroperitoneal organs was evaluated by CT in the preoperative supine and intraoperative prone position. The distances from the centre line of the intervertebral body to the organs including aorta, inferior vena cava, ascending and descending colons, and bilateral kidneys were measured for the lumbar spine. An “at risk” zone was defined as distance less than 10 mm anterior from the centre line of the intervertebral body.
Results
Compared to supine preoperative CTs, bilateral kidneys at the L2/3 level as well as the bilateral colons at the L3/4 level had statistically significant ventral shift with prone positioning. The proportion of retroperitoneal organs within the at-risk zone ranged from 29.6 to 88.6% in the prone position.
Conclusions
The retroperitoneal organs shifted ventrally with prone positioning. However, the amount of shift was not large enough to avoid risk for organ injuries and substantial proportion of patients had organs within the cage insertion corridor. Careful preoperative planning is warranted when considering single-prone LLIF.
Retrospective case-control study.
To determine the association of Hounsfield unit (HU) measurements with adjacent segment fractures after spinal fusion.
Adjacent segment fracture is a potentially ...devastating complication after spinal fusion surgery in osteoporotic patient. Recently, a technique for assessing bone mineral density using HU measurements from computed tomography was described and correlated with both dual-energy x-ray absorptiometry-assessed bone mineral density and compressive strength in an osseous model.
Patients with adjacent segment fractures after spinal fusion were identified from a prospectively collected patient database and matched 1:1 with nonfracture controls on the basis of age, sex, and fusion construct. Minimum follow-up was 6 months. Patients with metabolic bone disease other than osteoporosis or those taking medications known to negatively alter bone strength were excluded. HU assessment was done according to the previously published protocol using the preoperative computed tomography.
Twenty patients had complete imaging data and could be matched to nonfracture controls. The groups were well matched with respect to age, sex, body mass index, and number of levels fused. Following the index surgical procedure, the fracture group had more positive sagittal balance than the control group (10.7 cm vs. 9.1 cm). Analysis of HU values at the fracture level showed a significantly lower value in the fracture group than in the controls (145.6 vs. 199.4, P = 0.006). Similarly, global assessment of HU across the thoracic and lumbar spines was significantly lower in the fracture group (139.9 vs. 170.1, P = 0.032).
HU was significantly lower both locally and globally in the fracture cohort. Because computed tomographic scans are frequently part of preoperative planning for spinal fusion, this information should be incorporated in preoperative planning. Studies to prospectively validate HU as a predictor of adjacent segment fracture risk and to assess the effect of increasing HU preoperatively with medications for osteoporosis are needed.
3.
Lateral lumbar interbody fusion can be performed without supplemental posterior instrumentation. Previous reports have shown favorable results with stand-alone lateral lumbar interbody fusion ...(SA-LLIF); however, a reoperation rate of up to 26% has been reported. It remains unclear what perioperative factors are associated with early failure after SA-LLIF. The objective of this study is to determine perioperative factors that increase the risk of early revisions after SA-LLIF.
Data of consecutive patients with SA-LLIF were reviewed. All revisions or recommendations for revision surgery within 12 months after the LLIF procedure were documented. As potential contributors, operative levels, preoperative clinical diagnosis, number of fusion levels, and the average L1/L2 quantitative computed tomography–volumetric bone mineral density value were obtained along with other demographic factors. Cage subsidence (grade 0–III as per Marchi et al.), was also evaluated in patients who had radiographs/computed tomography between 6 and 12 months postoperatively (n = 122). Logistic regression analyses were conducted.
Of 133 eligible patients, 21 (15.8%) underwent revision surgery and 4 (3.0%) were recommended for revision surgery within 1 year primarily because of neurologic symptoms or pain (68%). Baseline demographics showed no significant difference between the revision and the nonrevision group. The average number of levels fused was 2.12 (revision group) and 2.14 (nonrevision group) (P = 0.55). Significantly more patients in the revision group had the diagnosis of foraminal stenosis (64.0% vs. 39.8%; P = 0.04).
Patients with foraminal stenosis were more likely to have early revision surgery after SA-LLIF primarily because of neurologic symptoms/pain. This information can assist in preoperative discussions and management of patient expectations.
Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the ...literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry.
This study included papers published in peer-reviewed journals dealing with functional imaging in OCD.
Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data.
Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.
Abstract
Background
The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, ...the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM;
erector spinae and multifidus
) interact with each other.
Methods
A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FI
PPM
were defined according to literature and patients were divided into two groups (< or ≥ 50% FI
PPM
).
Results
One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m
2
met the inclusion criteria and were analyzed. Patients with a FI
PPM
≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FI
PPM
and FI
Psoas
for both sexes. A significant positive correlation between FAT
PPM
and fCSA
Psoas
was also found for both sexes. No significant differences were found for both sexes in both FI
PPM
groups.
Conclusion
As the FI
PPM
increases, the FI
Psoas
decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background context Lateral lumbar interbody fusion (LLIF) has become an increasingly common minimally invasive procedure for selective degenerative deformity correction, reduction of ...low-grade spondylolisthesis, and indirect foraminal decompression. Concerns remain about the safety of the transpsoas approach to the spine due to proximity of the lumbosacral plexus. Purpose To address risk factors for iatrogenic nerve injury in a large cohort of patients undergoing LLIF. Study design Retrospective analysis of 919 LLIF procedures to identify risk factors for lumbosacral plexus injuries. Methods The medical charts of patients who underwent transpsoas interbody fusion with or without supplemental posterior fusion for degenerative spinal conditions over a 6-year period were retrospectively reviewed. Patients with prior lumbar spine surgery or follow-up of less than 6 months were excluded. Factors that may affect the neurologic outcome were investigated in a subset of patients who underwent stand-alone LLIF. Results Four hundred fifty-one patients (males/females: 179/272) met the inclusion criteria and were followed for a mean of 15 months (range, 6–53 months). Average age at the time of surgery was 63 years (range, 24–90 years). Average body mass index was 29 kg/m2 (range, 17–65 kg/m2 ). A total of 919 levels were treated (mean, 2 levels per patient). Immediately after surgery, 38.5% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 38% and 23.9% of the patients, respectively. At the last follow-up, 4.8% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 24.1% and 17.3% of the patients, respectively. When patients with neural deficits present before surgery were excluded, persistent surgery-related sensory and motor deficits were identified in 9.3% and 3.2% of the patients, respectively. Among 87 patients with minimum follow-up of 18 months, persistent surgery-related sensory and motor deficits were recorded in 9.6% and 2.3% of the patients, respectively. Among patients with stand-alone LLIF, the level treated was identified as a risk factor for postoperative lumbosacral plexus injury. The use of recombinant human bone morphogenetic protein 2 was associated with persistent motor deficits. Conclusions Although LLIF is associated with an increased prevalence of anterior thigh/groin pain as well as motor and sensory deficits immediately after surgery, our results support that pain and neurologic deficits decrease over time. The level treated appears to be a risk factor for lumbosacral plexus injury.
A general consensus has not yet been reached regarding the role of disorganization symptoms in real-world functioning in schizophrenia.
We used structural equations modeling (SEM) to analyze the ...direct and indirect associations between disorganization and real-world functioning assessed through the Specific Levels of Functioning Scale (SLOF) in 880 subjects with schizophrenia.
We found that: 1) conceptual disorganization was directly and strongly connected with SLOF daily activities; difficulty in abstract thinking was associated with moderate strength to all SLOF domains, and poor attention was connected with SLOF work skills; 2) grandiosity was only related with poor work skills, and delusions were associated with poor functioning in all SLOF domains; interpersonal relationships were weakly indirectly influenced by hallucinatory behavior, delusions and unusual thought contents through the mediation of social cognition (SC); 3) among the negative symptoms, avolition had only direct links with SLOF work skills and SLOF activities; anhedonia had direct links with SLOF work skills and SLOF interpersonal and indirect link with SLOF work skills through functional capacity (FC); asociality with SLOF interpersonal; blunted affect had direct links with SLOF activities and indirect links with SLOF interpersonal relationships mediated by SC. Lastly, alogia had only indirect links mediated by SC, FC, and neurocognition (NC).
Overall conceptual disorganization is the symptom that contributed more (both directly and indirectly) to the activities of community living in real-world. Thus, it should be considered as a treatment target in intervention programs for patients with schizophrenia.
Summary
Introduction
Research has demonstrated that patients with insomnia are at an increased risk of experiencing suicidal ideation and/or making a suicide attempt.
Objectives
To evaluate the ...relation between insomnia and suicidal behaviour.
Aims
To examine factors associated with a diagnosis of insomnia in patients admitted to an Emergency Department (ED) and assessed by the psychiatrist in charge.
Methods
Participants were 843 patients consecutively admitted to the ED of Sant'Andrea Hospital in Rome, between January 2010 and December 2011. All patients admitted were referred to a psychiatrist. A clinical interview based on the Mini International Neuropsychiatric Interview (MINI) and a semi‐structured interview was conducted. Patients were asked about ‘ongoing’ suicidal ideation or plans for suicide.
Results
Forty‐eight percent of patients received a diagnosis of bipolar disorder (BD), major depressive disorder (MDD) or an anxiety disorder; whereas, 17.1% were diagnosed with Schizophrenia or other non‐affective psychosis. Patients with insomnia (compared to patients without insomnia) more frequently had a diagnosis of BD (23.9% vs. 12.4%) or MDD (13.3% vs. 9.5%; p < 0.001). Moreover, patients with insomnia less frequently had attempted suicide in the past 24 h (5.3% vs. 9.5%; p < 0.05) as compared with other patients, but those patients with insomnia who attempted suicide more frequently used a violent method (64.3% vs. 23.6%; p < 0.01) compared to other suicide attempters.
Conclusions
Our results do not support an association between insomnia and suicidal behaviour. However, suicide attempters with insomnia more frequently used violent methods, and this phenomenon should be taken into serious consideration by clinicians.
Lumbar Spine Surgery in Patients with Parkinson Disease Schroeder, Joshua E., MD; Kaplan, Leon, MD; Hughes, Alexander, MD ...
Journal of bone and joint surgery. American volume,
2015-October-21, Letnik:
97, Številka:
20
Journal Article
Recenzirano
Background Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have ...been reported. Methods All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients’ charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed. Results Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was <2 in thirteen patients, 2 in thirty patients, 2.5 in twenty-three patients, and ≥3 in thirty patients. The primary indication for surgery was spinal stenosis in seventy-two patients, spondylolisthesis in seventeen patients, and coronal and/or sagittal deformity in seven patients. There were nineteen early complications, including postoperative infections requiring surgical irrigation and debridement and long-term antibiotics in ten patients. The visual analog scale for back pain improved from 7.4 cm preoperatively to 1.8 cm postoperatively (p < 0.001). The visual analog scale for lower-limb pain improved from 7.7 cm preoperatively to 2.3 cm postoperatively (p < 0.001). The Oswestry Disability Index score dropped from 54.1 points to 17.7 points at the time of the latest follow-up (p < 0.001). The Short Form-12 Physical Component Summary score improved from 26.6 points preoperatively to 30.5 points postoperatively (p < 0.05). Twenty patients required revision surgery. Risks for further surgery included a Parkinson disease severity stage of ≥3 (p < 0.05), a history of diabetes mellitus, treatment for osteoporosis, and a combined anterior and posterior approach. Conclusions Despite a higher rate of complications than in the general population, the overall outcome of spine surgery in patients with mild to moderate Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted. Level of Evidence Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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