The number of cervical spine fusion surgeries performed in the United States has risen significantly. Despite this trend, there is limited research on the outcomes of long constructs involving the ...entire subaxial cervical spine, making it difficult for surgeons to counsel patients on what to expect after an extensive posterior cervical fusion. In our study, we aimed to investigate the outcomes of long cervical fusion surgeries that span the entire cervical spine below C2.
The purpose of the study was to compare patient reported outcomes (PROs), complications and revision rates for long posterior cervical fusions with single-, 2-, 3 and 4-level ACDFs.
Retrospective review of prospective collected data at a single institution.
A total of 230 patients were included in the study.
VAS neck and arm pain, NDI and EQ5D were collected along with complications and surgical revision rates.
Patients ≥ 18 years of age who had undergone long cervical fusion constructs from C2 to T1, or T2 (7-level fusions) were included and compared to patients with 1-, 2-, 3- and 4-level ACDFs. We excluded patients with a primary diagnosis of cancer, tumor or infection. VAS, NDI, EQ5D PROs were compared between groups along with complications and surgical revision rates at 6-weeks, 3-months, 6-months and 1-year follow-up.
A total of 200 patients (106 female) were included with 193 primary surgeries and 7 revisions. Thirty-one 1-level, 46 2-level, 52 3-level, 21 4-level ACDFs and 50 long posterior cervical fusions (C2-T1/T2) with mean age 56.7 (SD 13.7), 53.6 (SD9.9), 61.1 (SD9.9), 59.2 (SD10.6) and 65.4 (SD9.3; p≤0.05), respectively. The 7-level group showed a MCID at 1-year for the neck VAS (2.1 SD 0.6), NDI (10.27 SD 5.2) and EQ5D (-0.17 SD 0.1) p≤0.05. No difference in VAS neck pain between the single level ACDF and C2-T1 groups 6 wks, 3 mos, 6 mos or 1-year follow-up (p≥ 0.05). Mean NDI score difference between these groups at 1-year was of 19.1 (p≤0.05) but no difference was seen for the EQ5D score at all time points (p≥0.05). Blood loss for 1-level ACDFs was 25.81 ml compared to 488.3 ml in the long posterior cervical group (p≥ 0.05). Two C5 palsies occurred in the posterior group compared to one in the 3-level ACDF group. No difference in surgical revision rates between the C2-T1 group and the other groups was determined (p≥0.05).
Patients with a long posterior cervical fusion had similar outcomes, complications and revision rates but more blood loss than 1- to 4-level ACDFs. This may help surgeons counsel patients regarding the outcomes of this procedure.
This abstract does not discuss or include any applicable devices or drugs.
Adult presentation of bilateral dysplasia and dislocation is an extremely rare presentation. The management of adult hip dysplasia is to preserve the hip and reduce pain through surgical ...intervention. Hence, early diagnosis provides more options as the treatment dilemma with the late presentation is very complicated with debatable prognosis. The case presented is a 53-year old woman who complained of persistent pain in the hip region. On radiology, dysplasia and dislocation of both the hip joints were observed along with soft tissue abnormalities around the joint. In this case report, we discuss the underlying pathophysiology that might have led to the abnormal radiological and anatomical changes in the hip region and the possible treatment options in a conservatively managed case of developmental dysplasia of the hip (DDH).
Purpose
To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical ...features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS.
Methods
The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each. Kappa values were calculated to assess the inter- and intraobserver reliability for each of the four components separately.
Results
Interobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation was 0.94, 0.80, 0.87, and 1.00, respectively. Intraobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation were 0.91, 0.88, 0.87, and 0.97, respectively.
Conclusion
The UCSF DS classification system provides a novel framework for assessing DS based on radiographic and clinical parameters with established implications for surgical treatment. The almost perfect interobserver and intraobserver reliability observed for all components of this system demonstrates that it is simple and easy to use. In clinical practice, this classification may allow subclassification of similar patients into groups that may benefit from distinct treatment strategies, leading to the development of algorithms to help guide selection of an optimal surgical approach. Future work will focus on the clinical validation of this system, with the goal of providing for more evidence-based, standardized approaches to treatment and improved outcomes for patients with DS.
Introduction Dysphagia is a common complication after anterior cervical discectomy and fusion (ACDF), but it is not a routinely asked question in legacy patient-reported outcome measures ...(PROMs). This study analyzes whether there are associations between dysphagia and legacy outcome measures. Methods We retrospectively reviewed 168 patients who underwent ACDF surgery from 2017 to 2019 at a single institution. Demographics, anthropometric data, Neck Disability Index (NDI), Visual Analog Scale (VAS)-Arm and VAS-Neck Pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical and PROMIS-Mental scores, Charlson Comorbidity Index (CCI), and Eating Assessment Tool-10 (EAT-10) were obtained for each patient preoperatively and at one, three, six, and 12 months postoperatively. Pearson's correlation coefficients were used to evaluate the bivariate correlations between legacy, PROMIS, and EAT-10 measures. Results Significant but weak correlations existed between NDI and EAT-10 at one, three, and six months postoperatively (correlation coefficient (R) = 0.31, 0.42, and 0.34 at one, three, and six months, p < 0.001) and VAS-Neck Pain and EAT-10 scores at one, three, and six months postoperatively (R = 0.27, 0.30, and 0.28 at one, three, and six months, p ≤ 0.004). Both PROMIS-Physical and PROMIS-Mental scores showed significant but weak correlations with EAT-10 scores at three and six months postoperatively (R = -0.29 and -0.25, p ≤ 0.01, at three months and R = -0.25 and -0.28, p < 0.01, at six months). In all comparisons of EAT-10 scores with legacy outcome measures, the significance of correlations disappeared by 12 months postoperatively. In addition, there was a positive association between CCI and EAT-10 score (β = 0.37, p < 0.05). Conclusion Weak correlations exist between self-reported dysphagia scores and legacy patient-reported outcome measures in patients undergoing ACDF. The correlation strength decreases over time; therefore, dysphagia scores should be reported separately when looking at outcomes after ACDF. Patients with more comorbidities are also at increased risk for dysphagia.
A retrospective, single-center study.
The aim of this study was to assess radiographic fusion after anterior cervical discectomy and fusion (ACDF) supplemented with either demineralized bone matrix ...or ViviGen in a polyetheretherketone biomechanical interbody cage.
Cellular and noncellular allografts are utilized as adjuncts in attempts to improve fusion after ACDF. The purpose of this study was to assess radiographic fusion and clinical outcomes after ACDF supplemented with cellular or noncellular allografts.
A single surgeon's clinical practice database was interrogated for consecutive patients who underwent a primary ACDF using cellular or noncellular allograft from 2017 to 2019. These subjects were matched by age, sex, body mass index, smoking status, and levels operated. Patient demographic and preoperative and postoperative patient-reported outcome measures (PROMs) including Visual Analog Scale Pain, Neck Disability Index, EuroQol-5 Dimension (EQ-5D), Patient-Reported Outcomes Measurement Information System (PROMIS), and Eating Assessment Tool 10 were collected preoperatively and at 3, 6, and 12 months postoperatively. Radiographic evidence of fusion was determined by <2 mm motion between spinous processes on flexion and extension radiographs and assessing bony bridging at 3, 6, and 12 months postoperatively.
There were 68 total patients, with 34 patients in each group, and 69 and 67 operative levels in the cellular and noncellular allograft groups, respectively. There was no difference in age, sex, body mass index, or smoking status between groups ( P >0.05). There was no difference in number of 1-level, 2-level, 3-level, or 4-level ACDFs between cellular and noncellular groups ( P >0.05). At 3, 6, and 12 months postoperatively, there was no difference in the percent of operated levels with <2 mm motion between spinous processes, complete bony bridging, or both <2 mm motion and complete bony bridging in the cellular and noncellular groups ( P >0.05). There was no difference in the number of patients fused at all operated levels at 3, 6, or 12 months postoperatively ( P >0.05). No patient required revision ACDF for symptomatic pseudarthrosis. There was no significant difference in PROMs between the cellular and noncellular groups at 12 months postoperatively except for improved EQ-5D and PROMIS-physical in the cellular compared with noncellular group ( P =0.03).
Similar radiographic fusion rates were achieved with cellular and noncellular allografts at all operated levels with similar PROMs in the cellular and noncellular groups at 3, 6, and 12 months postoperatively. Thus, ACDFs supplemented with cellular allograft demonstrate adequate radiographic fusion rates when compared with noncellular allografts with similar patient outcomes.
Level III.
Background
Antibiotics for presumed small intestinal bacterial overgrowth have been shown to improve irritable bowel syndrome symptoms in at least 40 % of subjects. A lactulose breath test for small ...intestinal bacterial overgrowth has been used to select patients who will respond. However, its predictive value, using the classic definition of a positive lactulose breath test, has been disappointing.
Aims
We conducted a retrospective evaluation to study characteristics of the lactulose breath test that may be predictive of a response to antibiotics in patients with the irritable bowel syndrome.
Methods
A clinical practice database was interrogated for consecutive patients who had a lactulose breath test for irritable bowel syndrome symptoms and a subsequent antibiotic course. Hydrogen + methane levels with carbon dioxide correction were plotted against time. Various profiles of the breath test curves were catalogued and compared with respect to their predictive value for symptom response to antibiotics.
Results
Lactulose breath test graphs of 561 patients of all irritable bowel syndrome subtypes were grouped into categories based on their hydrogen + methane levels with respect to time. Of subjects whose hydrogen + methane rise was <20 ppm throughout the test (group 1;
N
= 95), 94.7 % improved after antibiotics (95 % CI 90.1–99.3). Of those with a rise <20 ppm within the first 90 min but a rise >50 ppm thereafter (group 3;
N
= 53), 47.2 % improved (95 % CI 33.7–60.6). The difference between groups 1 and 3 was statistically significant
P
< 0.001.
Conclusion
A lactulose breath test appears to be useful in predicting response to antibiotics in patients with the irritable bowel syndrome. A hydrogen + methane rise <20 ppm throughout the duration of the test is most predictive. This observation contradicts the classic definition of a positive lactulose breath test.
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