Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts

xloma.fota13 shared this article with you from Inoreader Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts Via Spine - Featured Articles - Featured Articles Study Design. Survey study. Objective. Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices. Summary of Background Data. Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes. Methods. A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure. Results. We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis

xloma.fota13 shared this article with you from Inoreader Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis Via Spine - Featured Articles - Featured Articles Study Design. A systematic review and single-arm meta-analysis of randomized clinical trials. Objective. The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). Summary of Background Data. There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. Methods. On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. Results. The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted. Level of Evidence: 1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure: Case Report and Literature Review

xloma.fota13 shared this article with you from Inoreader Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure: Case Report and Literature Review Via Spine - Featured Articles - Featured Articles Study Design. Case-report and literature review. Objective. To depict main features of a potentially deleterious postoperative spinal fixation complication. Summary of Background Data. Tisular deposit of metal particles from prosthetic systems—metallosis—is an uncommon complication of spinal fixation surgery. Manifestations as chronic postoperative pain, instrumentation failure, infection, or neurological impairment can be developed, but metallosis often appears as an unexpected intraoperative finding. Methods. A 70-year-old female underwent several spinal fixation procedures due to progressive degenerative adult scoliosis, who developed instrumentation failure. Unexpected metallosis was evidenced extensively surrounding the dislodged construct due to vertebral osteolysis. Instrumentation replacement and debridement of metallotic tissue was performed. We also conduct a literature review for the terms "spinal metallosis" and "spinal corrosion" on the PubMed/MEDLINE database. Previous publications depicting black/dark staining, discoloration and/or fibrotic tissue, as well as histopathological metal particle deposits, or merely metallosis, were reviewed. Articles reporting individual cases or case-series/cohorts with patient-discriminated findings were included. Results. The histopathological analysis of our patient revealed dense fibroconnective tissue with black metallic pigment associated. She evolved with great pain relief in the immediately postoperative period. The patient achieved pain-free standing with significant pharmacotherapy reduction and independent ambulation. The literature search retrieved 26 articles for "spinal metallosis" and 116 for "spinal corrosion"; 16 articles met selection criteria. Approximately 60% of the reported cases accounted for patients younger than 30 years old, mainly related to expandable fixation system (65%) for idiopathic scoliosis. Usually, the symptoms were correlated with abnormal radiological findings: instrumentation breakage, dislodgement, loosening, expandable systems fracture. All the reviewed patients evolved free of pain and neurologically recovered. Conclusion. Instrumentation removal and metallosis debridement seems to be useful for symptomatic patients, but remains controversial on fixed asymptomatic patients. If solid fusion has not been achieved, extension, and reinforcement of the failed fixation could be required. Level of Evidence: 4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis

xloma.fota13 shared this article with you from Inoreader Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis Via Spine - Featured Articles - Featured Articles Study Design. Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial. Objective. The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis. Summary of Background Data. Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis. Methods. This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups. Results. Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis. Conclusion. While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis

xloma.fota13 shared this article with you from Inoreader Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis Via Spine - Featured Articles - Featured Articles Study Design. Retrospective cohort. Objective. The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day all-cause readmission in patients undergoing single-level lumbar fusions. Summary of Background Data. Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. Methods. MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day all-cause readmission. Results. The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

In-hospital Course and Complications of Laminectomy Alone Versus Laminectomy Plus Instrumented Posterolateral Fusion for Lumbar Degenerative Spondylolisthesis: A Retrospective Analysis of 1804 Patients from the NSQIP Database

xloma.fota13 shared this article with you from Inoreader In-hospital Course and Complications of Laminectomy Alone Versus Laminectomy Plus Instrumented Posterolateral Fusion for Lumbar Degenerative Spondylolisthesis: A Retrospective Analysis of 1804 Patients from the NSQIP Database Via Spine - Featured Articles - Featured Articles Study Design. Retrospective analysis of data from the National Surgical Quality Improvement Program (NSQIP). Objective. We sought to compare the short-term outcomes of laminectomy with/without fusion for single-level lumbar degenerative spondylolisthesis (DS). Summary of Background Data. Lumbar DS is a common cause of low back and radicular pain. Controversy remains over the safety and efficacy of fusion in addition to standard decompressive surgery. Methods. Patients with lumbar DS who underwent laminectomy alone or laminectomy plus posterolateral fusion at a single level were identified from the 2012–2017 NSQIP database. Outcomes included 30-day mortality, major complication, reoperation, readmission, as well as operative duration, need for blood transfusion, length of stay (LOS), and discharge destination. Outcomes were compared between treatment groups by multivariable regression, adjusting for age, sex, and comorbidities (modified Frailty Index). Effect sizes were reported by adjusted odds ratio (aOR) or mean difference (aMD). Results. The study cohort consisted of 1804 patients; of these, 802 underwent laminectomy alone and 1002 laminectomy plus fusion. On both unadjusted and adjusted analyses, there was no difference in 30-day mortality, major complications, reoperation, or readmission. However, laminectomy plus fusion was associated with longer operative time (170.0 vs. 152.7 minutes; aMD 16.00 minutes, P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical Site Infection, Readmission, and Reoperation After Posterior Long Segment Fusion

xloma.fota13 shared this article with you from Inoreader Surgical Site Infection, Readmission, and Reoperation After Posterior Long Segment Fusion Via Spine - Featured Articles - Featured Articles Study Design. Retrospective case series. Objective. We sought to identify risk factors associated with surgical site infection (SSI) after posterior long segment spinal fusion (PLSF). Summary of Background Data. Patients who undergo PLSF may be at elevated risk of SSI. Identifying factors associated with SSI in these operations can help risk stratify patients and tailor management. Methods. We analyzed PLSFs—seven or more levels—at our institution from 2000 to 2015. Data on patients' clinical characteristics, procedural factors, and antimicrobial management were collected. Multivariable analysis identified factors independently associated with outcomes of interest. Results. In 628 cases, SSI was associated with steroid use (P = 0.024, odds ratio [OR] = 2.54) and using cefazolin (P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cancers, Vol. 13, Pages 1891: Tumor Solid Stress: Assessment with MR Elastography under Compression of Patient-Derived Hepatocellular Carcinomas and Cholangiocarcinomas Xenografted in Mice

xloma.fota13 shared this article with you from Inoreader Cancers, Vol. 13, Pages 1891: Tumor Solid Stress: Assessment with MR Elastography under Compression of Patient-Derived Hepatocellular Carcinomas and Cholangiocarcinomas Xenografted in Mice Via Cancers Cancers, Vol. 13, Pages 1891: Tumor Solid Stress: Assessment with MR Elastography under Compression of Patient-Derived Hepatocellular Carcinomas and Cholangiocarcinomas Xenografted in Mice Cancers doi: 10.3390/cancers13081891 Authors: Gwenaël Pagé Marion Tardieu Jean-Luc Gennisson Laurent Besret Philippe Garteiser Bernard E. Van Beers Malignant tumors have abnormal biomechanical characteristics, including high viscoelasticity, solid stress, and interstitial fluid pressure. Magnetic resonance (MR) elastography is increasingly used to non-invasively assess tissue viscoelasticity. However, solid stress and interstitial fluid pressure measurements are performed with invasive methods. We studied the feasibility and potential role of MR elastography at basal state and under controlled compression in assessing altered biomechanical features of malignant liver tumors. MR elastography was performed in mice with patient-derived, subcutaneously xenografted hepatocellular carcinomas or cholangiocarcinomas to measure the basal viscoelasticity and the compression stiffening rate, which corresponds to the slope of elasticity versus applied compression. MR elastography measurements were correlated with invasive pressure measurements and digital histological readings. Significant differences in MR elastography parameters, pres sure, and histological measurements were observed between tumor models. In multivariate analysis, collagen content and interstitial fluid pressure were determinants of basal viscoelasticity, whereas solid stress, in addition to collagen content, cellularity, and tumor type, was an independent determinant of compression stiffening rate. Compression stiffening rate had high AUC (0.87 ± 0.08) for determining elevated solid stress, whereas basal elasticity had high AUC for tumor collagen content (AUC: 0.86 ± 0.08). Our results suggest that MR elastography compression stiffening rate, in contrast to basal viscoelasticity, is a potential marker of solid stress in malignant liver tumors. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease patients of different age groups

xloma.fota13 shared this article with you from Inoreader Characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease patients of different age groups Via pubmed: dysphagia Zhonghua Yi Xue Za Zhi. 2021 Apr 13;101(14):1015-1019. doi: 10.3760/cma.j.cn112137-20200713-02110. ABSTRACT Objective: To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease (GERD) patients of different age groups. Methods: This was a case-control study. Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups: elderly group (≥60 years old) and young and middle-aged group (<60 years old). Characteristics of gender, disease course, clinical symptoms, esophageal motility, gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed. Results: A total of 250 patients met the inclusion criteria, with 61 patients in elderly group and 189 in young and middle-aged group. There were no significant differ ences in gender ((male/female: 24/37 vs 78/111, P>0.05) and disease course((4.9±4.2) years vs(4.5±3.8)years, P>0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43, P<0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg, P<0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),P<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0), P<0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); both P<0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(r=-0.145, P<0.05), while there was a positive correlation between the LES length and age (r=0.129, P<0.05). Conclusion: Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients. PMID:33845540 | DOI:10.3760/cma.j.cn112137-20200713-02110 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Botulinum toxin type A versus anticholinergics for cervical dystonia

xloma.fota13 shared this article with you from Inoreader Botulinum toxin type A versus anticholinergics for cervical dystonia Via pubmed: dysphagia Cochrane Database Syst Rev. 2021 Apr 14;4:CD004312. doi: 10.1002/14651858.CD004312.pub3. ABSTRACT BACKGROUND: This is an update of a Cochrane Review first published in 2005. Cervical dystonia is the most common form of focal dystonia and is a highly disabling movement disorder, characterised by involuntary, usually painful, head posturing. Currently, botulinum toxin type A (BtA) is considered the first line therapy for this condition. Before BtA, anticholinergics were the most widely accepted treatment. OBJECTIVES: To compare the efficacy, safety, and tolerability of BtA versus anticholinergic drugs in adults with cervical dystonia. SEARCH METHODS: We searched the Cochrane Movement Disorders' Trials Register to June 2003, screened reference lists of articles and conference proceedings to September 2018, and searched CENTRAL, MEDLINE, and Embase, with no language restrictions, to July 2020. SELECTION CRITERIA: Double-blind, p arallel, randomised trials (RCTs) of BtA versus anticholinergic drugs in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias and quality of the evidence. We resolved disagreements by consensus or by consulting a third review author. If enough data had been available, we were to perform meta-analyses using a random-effects model for the comparison of BtA versus anticholinergic drugs to estimate pooled effects and corresponding 95% confidence intervals (95% CI). The primary efficacy outcome was improvement in cervical dystonia-specific impairment. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS: We included one RCT of moderate overall risk of bias (as multiple domains were at unclear risk of bias), which included 66 BtA-naive participants with cervical dystonia. Two d oses of BtA (Dysport; week 0 and 8; mean dose 262 to 292 U) were compared with daily trihexyphenidyl (up to 24 mg daily). The trial was sponsored by the BtA producer. BtA reduced cervical dystonia severity by an average of 2.5 points (95% CI 0.68 to 4.32) on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale 12 weeks after injection, compared to trihexyphenidyl. More participants reported adverse events in the trihexyphenidyl treatment group (76 events), compared with the BtA group (31 events); however, the difference in dropouts due to adverse events was inconclusive between groups. There was a decreased risk of dry mouth, and memory problems with BtA, but the differences were inconclusive between groups for the other reported side effects (blurred vision, dizziness, depression, fatigue, pain at injection site, dysphagia, and neck weakness). AUTHORS' CONCLUSIONS: We found very low-certainty evidence that BtA is more effective, better tolerated, and safer than trihexyphenidyl. We found no information on a dose-response relationship with BtA, differences between BtA formulations or different anticholinergics, the utility of electromyography-guided injections, or the duration of treatment effect. PMID:33852744 | DOI:10.1002/14651858.CD004312.pub3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recurrence of dysphagia post-myotomy: etiologies and management

xloma.fota13 shared this article with you from Inoreader Recurrence of dysphagia post-myotomy: etiologies and management Via pubmed: dysphagia Rev Col Bras Cir. 2021 Apr 9;48:e20202973. doi: 10.1590/0100-6991e-20202973. eCollection 2021. NO ABSTRACT PMID:33852705 | DOI:10.1590/0100-6991e-20202973 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.