Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair ...spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.
This was a retrospective multivariate analysis of preoperative risk factors leading to intensive care unit (ICU) admissions in patients undergoing elective or acute dorsal spine surgery.
Numerous ...studies have predicted a substantial increase in spine surgeries within the next decades, potentially overwhelming hospitals' resources, including ICU occupancy. Accurate estimates of whether patients need postsurgical ICU treatment are pivotal for both resource allocation and patient safety.
Risk factors leading to ICU admissions after dorsal spine surgery have been extensively examined for lumbar elective surgery. Studies including other anatomical segments of the spine and nonelective surgery regarding postsurgical ICU treatment probability are lacking.
This study was designed to be a single-center multivariate analysis of data retrospectively collected from a tertiary care university hospital. Patients undergoing dorsal spine surgery from 2009 to 2019 were included in this study. The patients' demographic data were analyzed to determine potential preoperative risk factors for ICU admission after surgery using multiple logistic regression.
In our cohort, 962 patients with a mean age of 71.1±0.55 years were included. Surgeries involved 3.24±0.08 spinal levels on average. The incidence of ICU treatment after surgery was 30.4% (n=292). Multivariate logistic regression showed a markedly increased odds ratio (OR) for patients undergoing surgery of the cervicothoracic junction (OR, 8.86) and those undergoing surgery for spinal deformity treatment (OR, 7.7). Additionally, cervical procedures (OR, 3.29), American Society of Anesthesiologists (ASA) class 3-4 (OR, 2.74), spondylodiscitis (OR, 2.47), fusion of ≥3 levels (OR, 1.94), and age >75 years (OR, 1.33) were associated with an increased risk of postsurgical ICU admission.
The findings highlight the relevance of anatomical location, preoperative diagnosis, ASA class, and length of surgery regarding the predictability of postoperative ICU admission. Our data allowed for more sophisticated estimates regarding the need for ICU treatment after dorsal spine surgery, guiding the surgeon through patient selection, communication, and ICU admission predictability.
Purpose
The purpose of this study was to outline the feasibility of continuous epidural analgesia in the treatment of failed back surgery syndrome (FBSS) or spinal stenosis.
Methods
We queried our ...prospective collected institutional database to include all consecutive patients, who underwent continuous epidural analgesia with accompanying intensive physiotherapeutic exercise within a timeframe of 4 years. Patients suffered from FBSS or spinal stenosis; protocolled continuous epidural analgesia was planned for 4 days within the framework of an inpatient multimodal pain therapy concept. The instillation technique of the epidural catheter, the capability to attend in accompanying physiotherapy, and the peri-interventional complications were evaluated.
Results
153 patients with an average age of 57.4 years (± 11.9) were enrolled in this study. 105 patients suffered from FBSS and 48 patients had spinal stenosis. Overall, 148 patients (96.7%) reported the pain reduction and were able to perform daily intensified physiotherapeutic exercise. There were no serious adverse events, neither infection nor bleeding, no cardiopulmonary complication or permanent neurological deficits. The most common side effect was neurological impairment, such as numbness, dysesthesia, or weakness of the lower limbs with complete regression after flow rate adjustment. Patients with FBSS were more likely to develop dysesthesia (
p
= 0.007).
Conclusions
Continuous epidural analgesia is feasible in patients with FBSS or spinal stenosis. This treatment enables extensive physiotherapeutic treatment even in patients with severe pain conditions and can be considered as an alternative to epidural injections. An increased complication rate in comparison to short-term perioperative or perinatal application was not observed.
Objective: Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a promising novel surgical approach. However, to date, there is a paucity of data regarding safety, ...efficacy, and functional outcomes following CE-ULBD.Methods: The aim of this study was to investigate the outcomes of outpatient CE-ULBD combined with postoperative smartphone-based continuous physiological monitoring and virtual follow-up. Results: We included a total of 23 patients in our study group. The mean age was 69.1±2.5 years. A significant postoperative reduction of the visual analogue scale for neck pain (4.1±0.6 pre- vs. 2.3±0.5 post-surgery; P<0.0001) and upper extremity pain (2.6±0.6 vs. 1.1±0.3; P=0.0012) was reported alongside a significant improvement in the Neck Disability Index (18.6±2.5 vs. 9.1±2.5; p=0.032). Eleven patients were monitored with continuous physiological monitoring via a smartphone app (SPINEHealthie ). Those patients were more likely to be outpatients (p=0.0002) and less likely to have postoperative inpatient clinic utilization (p<0.0001). Continuous physiological monitoring suggested a trend towards higher levels of function in patients following CE-ULBD. Conclusion: : Our early results suggest that outpatient CE-ULBD followed by virtual postoperative monitoring is a safe and efficient therapeutic intervention for symptomatic cervical spinal stenosis.
The anatomical reconstruction of the wrist is the aim when treating distal radius fractures. Current literature on the importance of preoperative reduction in fractures that are treated operatively ...is limited.
This study investigated the effect of the preoperative closed reduction of distal radius fractures on the day of trauma and the time to surgery on postoperative palmar inclination. A total of eighty patients (48 females and 32 males, mean age 55.6 years) were studied retrospectively. All patients were treated with an open reduction and internal fixation. The palmar inclination angle was measured using X-rays by two investigators, and the interobservers and pre- and post-reduction parameters were compared.
When the surgical management of closed distal radius fractures is required, neither initial repositioning nor a delay of up to 14 days to the surgical treatment influences postoperative palmar inclination.
The significance of preoperative reduction of distal radius fractures without neurovascular or extensive soft tissue damage is limited and is not leading to improved outcomes. When surgery is about to be performed, surgeons should carefully consider if reduction is really vital preoperatively. Level of evidence: III.
Bisphenol A (BPA), which is contained in numerous plastic products, is known to act as an endocrine-disruptive, toxic, and carcinogenic chemical. This experimental series sought to determine the ...influence of BPA exposure on the femoral bone architecture and biomechanical properties of male and female Wistar rats. BPA was applied subcutaneously by using osmotic pumps. After 12 weeks, the bones were analyzed by micro-computed tomography (micro-CT) and a three-point bending test. Comparing the female low- and high-dose groups, a significantly greater marrow area (
= 0.047) was identified in the group exposed to a higher BPA concentration. In addition, the trabecular number tended to be higher in the female high-dose group when compared to the low-dose group (
> 0.05). The area moment of inertia also tended to be higher in the male high-dose group when compared to the male low-dose group (
> 0.05). Considering our results, BPA-related effects on the bone morphology in female Wistar rats are osteoanabolic after high-dose exposure, while, in male rats, a tendency toward negative effects on the bone morphology in terms of a reduced cross-sectional cortical area and total area could be demonstrated.
Objective
To assess which radiological alignment parameters are associated with a satisfactory long‐term clinical outcome after performing lumbar spinal fusion for treating degenerative ...spondylolisthesis.
Methods
This single‐center prospective study assessed the relation between radiological alignment parameters measured on standing lateral lumbar spine radiographs and the patient‐reported outcome using four different questionnaires (COMI, EQ‐5D, ODI and VAS) as primary outcome measures (level of evidence: II). The following spinopelvic alignment parameters were used: gliding angle, sacral inclination, anterior displacement, sagittal rotation, lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Furthermore, the length of stay and perioperative complications were documented. Only cases from 2013 to 2015 of low‐grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) were considered. The patients underwent open posterior lumbar fusion surgery by pedicle screw instrumentation and cage insertion. The operative technique was either a posterior lumbar interbody fusion (PLIF) or a transforaminal lumbar interbody fusion (TLIF) performed by three different senior orthopedic surgeons. Exclusion criteria were spine fractures, minimally invasive techniques, underlying malignant diseases or acute infections, previous or multisegmental spine surgery as well as preoperative neurologic impairment. Of 89 initially contacted patients, 17 patients were included for data analysis (11 males, six females).
Results
The data of 17 patients after mono‐ or bisegmental lumbar fusion surgery to treat low‐grade lumbar spondylolisthesis and with a follow‐up time of least 72 months were analyzed. The mean age was 66.7 ± 11.3 years. In terms of complications two dural tears and one intraoperative bleeding occurred. The average body mass index (BMI) was 27.6 ± 4.4 kg/m2 and the average inpatient length of stay was 12.9 ± 3.8 days (range: 8–21). The long‐term clinical outcome correlated significantly with the change of the pelvic tilt (rs = −0.515, P < 0.05) and the sagittal rotation (rs = −0.545, P < 0.05). The sacral slope was significantly associated with the sacral inclination (rs = 0.637, P < 0.01) and the pelvic incidence (rs = 0.500, P < 0.05). In addition, the pelvic incidence showed a significant correlation with the pelvic tilt (rs = 0.709, P < 0.01). The change of the different clinical scores over time also correlated significantly between the different questionnaires.
Conclusions
The surgical modification of the pelvic tilt and the sagittal rotation are the two radiological alignment parameters that can most accurately predict the long‐term clinical outcome after lumbar interbody fusion surgery.
Pre‐ and postoperative (PLIF L4/5) lateral standing radiographs of the lumbar spine are used to measure the pelvic tilt. The greater the difference of the pelvic tilt after fusion surgery compared to the preoperative value, the worse is the outcome after 6 years when quantified by the EQ‐5D questionnaire.
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.
INTRODUCTION:
Full-endoscopic unilateral laminotomy for bilateral lumbar decompression (ULBD) for spinal stenosis has proven benefits when compared to microscopic technique. Intraoperative laceration ...of the dura may be encountered and their optimal technique and effectiveness of full-endoscopic dural repair remains unclear.
METHODS:
For this analysis, we utilize a prospectively collected database of all patients undergoing ULBD from 2015 to 2021 at our institution. We evaluate whether patient specific factors such as sex, age, body mass index (BMI), smoking status, ASA level, number of levels, or previous index level surgery affects durotomy risk. We then determine whether having an intraoperative durotomy affects length of stay (LOS), revision surgery risk, length of time on postoperative pain medications, or Oswestry Disability Index (ODI) scores.
RESULTS:
In 174 patients undergoing ULBD, there were 11 patients who sustained intraoperative dural tears (6.3%). Utilizing our novel bimanual technique, there was only one patient who required temporary CSF drainage via a lumbar drain. None required revision surgery for CSF leak repair. Durotomy risk was not significantly affected by any patient specific risk factors. Sustaining a durotomy did increase LOS (p=0.033). Intraoperative durotomies did not affect revision surgery risk, or length of time on postoperative pain medications. Utilizing MCID of 12.8 increase in ODI, 70.8% of non-durotomy patients achieved the MCID goal versus 60.0% of durotomy patients. However this trend did not achieve statistical significance (p = 0.605).
CONCLUSION:
Our novel method of bimanual repair of CSF leaks in full-endoscopic spine surgery appears to be a safe and feasible. There are no patient specific risk factors affecting durotomy risk. Sustaining a durotomy intraoperatively affects LOS but does not significantly alter any other aspect of the postoperative course for patients undergoing ULBD.
Isthmic spondylolysis represents the most common cause of spinal pain in adolescent athletes. This article provides an overview of the classification, diagnosis, and treatment options for these ...conditions, including conservative and operative measures. It also provides a treatment pathway to how young athletes with spondylolysis should be treated.
Diagnostic imaging techniques are essential for an accurate diagnosis, with CT scans providing additional information for surgical planning.
Conservative treatment focuses on activity modification and physiotherapy, with a phased approach tailored to individual patient needs. Operative intervention may be considered if conservative measures fail, with minimally invasive techniques such as Buck's screw fixation showing promising results. The decision between conservative and operative management should consider factors of the patients' individual profile. In this paper, we present the first treatment algorithm for the treatment of isthmic spondylolysis. Long-term prognosis varies, with most athletes able to return to sport following treatment.
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