Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with ...patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care.
A comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients' pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality.
The search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates.
Patients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes.
PROSPERO registration number: CRD42020145151 .
Surgical site infections (SSIs) of the spine are morbid and costly complications. An accurate surveillance system is required to properly describe the disease burden and the impact of interventions ...that mitigate SSI risk. Unfortunately, uniform approaches to conducting SSI surveillance are lacking because of varying SSI case definitions, the lack of a perfect reference case definition and heterogeneous data sources.
To assess the accuracy of four independent data sources that capture SSIs after spine surgery, with estimation of a measurement-error-adjusted SSI incidence.
A Bayesian latent class model assessed the sensitivity/specificity of each data source to identify SSI and to estimate a measurement-error-adjusted incidence. The four data sources used were: the discharge abstract database (DAD), the National Surgical Quality Improvement Program (NSQIP) database, the Infection Prevention and Control Canada (IPAC) database, and the Spine Adverse Events Severity database.
A total of 904 patients underwent spine surgery in 2017. The most sensitive data source was DAD (0.799; 95% credible interval (CrI): 0.597–0.943); the least sensitive was NSQIP (0.497; 95% CrI: 0.308–0.694). The most specific data source was IPAC (0.997; 95% CrI: 0.993–1.000) and the least specific was DAD (0.969; 95% CrI: 0.956–0.981). The measurement-error-adjusted SSI incidence was 0.030 (95% CrI: 0.019–0.045). The crude incidence using the DAD overestimated the incidence, and the three other data sources underestimated it.
SSI surveillance in the spine surgery population is feasible using several data sources, provided that measurement error is considered.
CLEC12A is a myeloid inhibitory receptor that negatively regulates inflammation in mouse models of autoimmune and autoinflammatory arthritis. Reduced CLEC12A expression enhances myeloid cell ...activation and inflammation in CLEC12A knock-out mice with collagen antibody-induced or gout-like arthritis. Similarly to other C-type lectin receptors, CLEC12A harbours a stalk domain between its ligand binding and transmembrane domains. While it is presumed that the cysteines in the stalk domain have multimerisation properties, their role in CLEC12A expression and/or signaling remain unknown. We thus used site-directed mutagenesis to determine whether the stalk domain cysteines play a role in CLEC12A expression, internalisation, oligomerisation, and/or signaling. Mutation of C118 blocks CLEC12A transport through the secretory pathway diminishing its cell-surface expression. In contrast, mutating C130 does not affect CLEC12A cell-surface expression but increases its oligomerisation, inducing ligand-independent phosphorylation of the receptor. Moreover, we provide evidence that CLEC12A dimerisation is regulated in a redox-dependent manner. We also show that antibody-induced CLEC12A cross-linking induces flotillin oligomerisation in insoluble membrane domains in which CLEC12A signals. Taken together, these data indicate that the stalk cysteines in CLEC12A differentially modulate this inhibitory receptor’s expression, oligomerisation and signaling, suggestive of the regulation of CLEC12A in a redox-dependent manner during inflammation.
Prospective cohort study.
Among patients with CSM, we aimed to evaluate the extent to which: (1) Preoperative cervical sagittal alignment is associated with health-related quality of life, function, ...and symptoms; (2) Surgery leads to changes in cervical sagittal alignment; and (3) Postoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms at 12 months of follow-up.
The importance of maintaining or improving cervical sagittal alignment in the surgical management of patients with CSM has not been established.
We measured C2-C7 Cobb angle, T1 slope, and C2-C7 cervical sagittal vertical axis (cSVA). We tested for associations with Neck Disability Index, Pain Scales for neck and arm pain, EuroQol 5D, Short Form 12 Physical and Mental Component Summaries, and modified Japanese Orthopaedic Association scores. We adjusted for potential confounders using multiple linear regression, and we performed various prespecified subgroup (cSVA > 40 mm, surgical approach) and sensitivity analyses.
Among 250 patients, adjusted analyses yielded significant inverse associations prior to surgery between each of cSVA and T1 slope with SF12 Physical Component Summaries (T1 slope: -0.14, 95% CI -0.26 to -0.01, P = 0.03; C2-C7 cSVA: -0.13, 95% CI --0.21 to -0.05 P < 0.01). Surgery was associated with a small but statistically significant increase in cSVA across the cohort (+5.8 mm SD 11.7, P < 0.01) but no change in Cobb angle or T1 slope. At 12-months after surgery, there were no significant associations between alignment parameters or change in alignment and any measures of health-related quality of life, function, or symptoms. Results were consistent across subgroup and sensitivity analyses.
Increased cSVA and T1 slope were associated with inferior health-related quality of life at presentation among patients with CSM, but no significant associations were observed following surgical treatment.Level of Evidence: 3.
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