Purpose
Patient reported outcome measures (PROMs) are important tools to assess patient function, pain, disability, and quality of life. We aim to study the efficiency and validity of digital PROMs ...collection using a smartphone app compared to traditional paper PROMs.
Methods
Patients undergoing evaluation for full-endoscopic spine surgery were recruited from the outpatient clinic at Harborview Medical Center. Visual analogue scale (VAS), Oswestry disability index (ODI), and EQ5-5D PROMs were administered on paper and through a smartphone app called SpineHealthie. Compliance rates were collected, and PROM results were assessed for correlation between paper and digital methods.
Results
123 patients were enrolled. 57.7% of patients completed paper PROMs, 82.9% completed digital PROMs, and 48.8% completed both. Of the patients that completed both, Spearman’s correlation was greatest for VAS leg, ODI, and EQ5 index scores. Correlation was weaker for VAS back pain, neck pain, and upper extremity pain. Patients tended to report lower disability and higher quality of life on the digital PROM compared to the paper PROM.
Conclusion
The SpineHealthie app effectively and accurately collects PROMs digitally, showing strong concordance with traditional paper PROMs. We conclude that digital PROMs constitute a promising strategy for monitoring patients after spine surgery over time.
Paralysis of the upper extremity severely restricts independence and quality of life after spinal cord injury. Regaining control of hand and arm movements is the highest treatment priority for people ...with paralysis, 6-fold higher than restoring walking ability. Nevertheless, current approaches to improve upper extremity function typically do not restore independence. Spinal cord stimulation is an emerging neuromodulation strategy to restore motor function. Recent studies using surgically implanted electrodes demonstrate impressive improvements in voluntary control of standing and stepping. Here we show that transcutaneous electrical stimulation of the spinal cord leads to rapid and sustained recovery of hand and arm function, even after complete paralysis. Notably, the magnitude of these improvements matched or exceeded previously reported results from surgically implanted stimulation. Additionally, muscle spasticity was reduced and autonomic functions including heart rate, thermoregulation, and bladder function improved. Perhaps most striking is that all six participants maintained their gains for at least three to six months beyond stimulation, indicating functional recovery mediated by long-term neuroplasticity. Several participants resumed their hobbies that require fine motor control, such as playing the guitar and oil painting, for the first time in up to 12 years since their injuries. Our findings demonstrate that non-invasive transcutaneous electrical stimulation of the spinal networks restores movement and function of the hands and arm for people with both complete paralysis and long-term spinal cord injury.
Upper extremity function is the highest priority of tetraplegics for improving quality of life. We aim to determine the therapeutic potential of transcutaneous electrical spinal cord stimulation for ...restoration of upper extremity function. We tested the hypothesis that cervical stimulation can facilitate neuroplasticity that results in long-lasting improvement in motor control. A 62-year-old male with C3, incomplete, chronic spinal cord injury (SCI) participated in the study. The intervention comprised three alternating periods: 1) transcutaneous spinal stimulation combined with physical therapy (PT); 2) identical PT only; and 3) a brief combination of stimulation and PT once again. Following four weeks of combined stimulation and physical therapy training, all of the following outcome measurements improved: the Graded Redefined Assessment of Strength, Sensation, and Prehension test score increased 52 points and upper extremity motor score improved 10 points. Pinch strength increased 2- to 7-fold in left and right hands, respectively. Sensation recovered on trunk dermatomes, and overall neurologic level of injury improved from C3 to C4. Most notably, functional gains persisted for over 3 month follow-up without further treatment. These data suggest that noninvasive electrical stimulation of spinal networks can promote neuroplasticity and long-term recovery following SCI.
BACKGROUND AND OBJECTIVES: Full-endoscopic sacroiliac joint denervation (FE-SJD) is a novel technique for the management of pain secondary to sacroiliac joint dysfunction. The aim of this study was ...to assess the long-term efficacy, safety, clinical outcomes, and outcome predictors of uniportal full-endoscopic sacroiliac joint denervation. METHODS: From 2019 to 2021, a total of 47 consecutive patients with pain secondary to sacroiliac joint dysfunction underwent uniportal FE-SJD through posterior approach by a single fellowship-trained spine surgeon. A retrospective analysis of perioperative parameters, complications, and clinical outcomes were obtained prospectively. RESULTS: The patient cohort had a mean age of 59.4 ± 14.0 years, with 63.8% females. Symptom duration averaged 62.1 ± 53.7 months. The mean operative time was 57.1 ± 16.8 minutes. All patients were discharged on the same day of surgery. Significant improvement was noted in preoperative visual analog score (back) and Oswestry Disability Index scores at 3, 6, 12 months, and 2 years ( P < .001). Thirty-four patients (72.3%) returned to normal functioning with an average of 82% pain relief and a satisfaction rate of 78.7% at a mean follow-up of 18.2 ± 13.1 months. There were no intraoperative complications. One patient had postoperative right L5 dysesthesia. Seven patients (14.9%) underwent contralateral FE-SJD due to satisfaction with the index procedure but residual pain on the contralateral side. Concomitant lumbar issues correlated with less functional improvement at 2 years ( P = .009). CONCLUSION: The long-term clinical results of FE-SJD are favorable. Endoscopic denervation of the dorsal rami branches supplying the sacroiliac joint represents a safe, effective, and durable option to address pain secondary to sacroiliac joint dysfunction. A significant factor that influences outcomes is the presence of concomitant lumbar pathology. Further research is needed to compare this technique with current available treatment options.
Minimally invasive spine procedures have undergone rapid development during the last decade. Efforts to decrease muscle crush injuries during prolonged retraction, avoid significant soft tissue ...stripping and minimize bony resection are surgical principles that are employed to prevent iatrogenic instability and provide patients with decreased post-operative pain and disability. Full-endoscopic spine surgery represents a tool for the spine surgeon to provide targeted access to spinal pathology utilizing these principles. Endoscopic techniques have seen over 30 years of evolution and innovation, however, early iterations of these techniques largely focused on transforaminal lumbar microdiscectomies. Currently, endoscopic techniques are utilized for approaching pathology in the cervical, thoracic and lumbar spine. There has been a growing body of literature that not only confirms the efficacy of these procedures but also underscores the advantages these procedures offer with respect to less morbidity and safer complication profiles. Endoscopic decompressions have been utilized in the settings of degenerative spinal stenosis, spondylolisthesis, scoliosis, previous fusion, tumor and infection. Furthermore, endoscopic interbody fusion has also been utilized in the lumbar spine as technology continues to advance. As technological innovation continues to facilitate reproducible surgical technique and expand the indications for use, we believe that endoscopic spine surgical techniques will provide surgeons with a more powerful and less morbid approach to spinal pathology that ultimately elevates the standard of care when treating our patients. We present a brief review of the history of endoscopic spine surgery, an overview of current techniques and review current outcomes of endoscopic spine surgical procedures in the context of an invasiveness/complexity index to elucidate the benefit zone of these newer techniques.
In this paper the authors' goal was to present their clinical experience with lesions of the pterygopalatine fossa, infratemporal fossa, lateral sphenoid sinus, cavernous sinus, petrous apex, and ...Meckel cave using simple and extended endoscopic transpterygoid approaches to the lateral skull base.
Simple and expanded endoscopic transpterygoid approaches were performed in a series of 13 patients with varying pathology that included lateral sphenoid sinus encephaloceles, benign and malignant sinonasal tumors, and lesions of neural origin.
A gross-total resection was achieved in 5 of 9 patients, while a subtotal resection for tissue diagnosis and cytoreduction prior to further adjuvant treatment was performed in the remaining patients. Sphenoid sinus encephaloceles were successfully repaired via a transpterygoid approach in all 4 patients. The skull base defect was reconstructed using a multilayered closure. One patient developed a postoperative CSF leak, which was successfully treated conservatively. The mean follow-up time was 16 months. Five patients complained of recurrent sinusitis. One patient experienced xerophthalmia and palate numbness. Three patients had died by the time of this report. Two patients died of unrelated causes. The third patient died of progression of an aggressive pterygopalatine osteosarcoma despite undergoing cytoreductive surgery and adjuvant chemotherapy.
An endoscopic transpterygoid approach is a minimally invasive endoscopic approach for lesions located or extending to the pterygopalatine fossa, infratemporal fossa, petrous apex, Meckel cave, and other regions of the paramedian skull base.
Innovations in Spinal Endoscopy Hussain, Ibrahim; Hofstetter, Christoph P.; Wang, Michael Y.
World neurosurgery,
April 2022, 2022-Apr, 2022-04-00, 20220401, Letnik:
160
Journal Article
Recenzirano
Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the ...cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. This ultra–minimally invasive technique has also enabled the performance of fusion procedures in awake patients under monitored anesthesia care, affording speedier recovery and treatment options for those unable to undergo general anesthesia. Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.
Bone morphogenetic protein (BMP) is frequently used for spinal arthrodesis procedures in an "off-label" fashion. Whereas complications related to BMP usage are well recognized, the role of dosage is ...less clear. The objective of this meta-analysis was to assess dose-dependent effectiveness (i.e., bone fusion) and morbidity of BMP used in common spinal arthrodesis procedures. A quantitative exploratory meta-analysis was conducted on studies reporting fusion and complication rates following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF) supplemented with BMP.
A literature search was performed to identify studies on BMP in spinal fusion procedures reporting fusion and/or complication rates. From the included studies, a database for each spinal fusion procedure, including patient demographic information, dose of BMP per level, and data regarding fusion rate and complication rates, was created. The incidence of fusion and complication rates was calculated and analyzed as a function of BMP dose. The methodological quality of all included studies was assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were analyzed using a random-effects model. Event rates are shown as percentages, with a 95% CI.
Forty-eight articles met the inclusion criteria: ACDF (n = 7), PCF (n = 6), ALIF (n = 9), TLIF/PLIF (n = 17), and PLF (n = 9), resulting in a total of 5890 patients. In ACDF, the lowest BMP concentration analyzed (0.2-0.6 mg/level) resulted in a fusion rate similar to the highest dose (1.1-2.1 mg/level), while permitting complication rates comparable to ACDF performed without BMP. The addition of BMP to multilevel constructs significantly (p < 0.001) increased the fusion rate (98.4% CI 95.4%-99.4%) versus the control group fusion rate (85.8% CI 77.4%-91.4%). Studies on PCF were of poor quality and suggest that BMP doses of ≤ 2.1 mg/level resulted in similar fusion rates as higher doses. Use of BMP in ALIF increased fusion rates from 79.1% (CI 57.6%-91.3%) in the control cohort to 96.9% (CI 92.3%-98.8%) in the BMP-treated group (p < 0.01). The rate of complications showed a positive correlation with the BMP dose used. Use of BMP in TLIF had only a minimal impact on fusion rates (95.0% CI 92.8%-96.5% vs 93.0% CI 78.1%-98.0% in control patients). In PLF, use of ≥ 8.5 mg BMP per level led to a significant increase of fusion rate (95.2%; CI 90.1%-97.8%) compared with the control group (75.3%; CI 64.1%-84.0%, p < 0.001). BMP did not alter the rate of complications when used in PLF.
The BMP doses used for various spinal arthrodesis procedures differed greatly between studies. This study provides BMP dosing recommendations for the most common spine procedures.
OBJECTIVEThe management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression ...(ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.METHODSA retrospective analysis of prospectively collected data was conducted on 45 consecutive LSS patients with concurrent scoliosis (≥ 10° coronal Cobb angle) and/or spondylolisthesis (≥ 3 mm). Patient demographics, operative details, complications, and imaging characteristics were reviewed. Outcomes were quantified using back and leg visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 1 year.RESULTSA total of 26 patients underwent full-endoscopic and 19 underwent MIS-ULBD with an average follow-up period of 12 months. The endoscopic cohort experienced a significantly shorter hospital length of stay (p = 0.014) and fewer adverse events (p = 0.010). Both cohorts experienced significant improvements in VAS and ODI scores at all time points (p < 0.001), but the endoscopic cohort demonstrated significantly better early ODI scores (p = 0.024).CONCLUSIONSEndoscopic and MIS-ULBD result in similar functional outcomes for LSS with mild to moderate deformity, while the endoscopic approach demonstrates a favorable rate of complications. Further studies are required to better delineate the characteristics of spinal deformities amenable to this approach and the durability of functional results.
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