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Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up
No full textIntroduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA (p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients (p < 0.001), but none of these measures improved significantly for nonop patients (p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed (p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures (p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p < 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability
Does hand stiffness reflect internal organ fibrosis in diabetes mellitus?
No full textFibrosis leads to irreversible stiffening of tissue and loss of function, and is a common pathway leading to morbidity and mortality in chronic disease. Diabetes mellitus (both type 1 and type 2 diabetes) are associated with significant fibrosis in internal organs, chiefly the kidney and heart, but also lung, liver and adipose tissue. Diabetes is also associated with the diabetic cheirarthropathies, a collection of clinical manifestations affecting the hand that include limited joint mobility (LJM), flexor tenosynovitis, Duypuytren disease and carpal tunnel syndrome. Histo-morphologically these are profibrotic conditions affecting various soft tissue components in the hand. We hypothesize that these hand manifestations reflect a systemic profibrotic state, and are potential clinical biomarkers of current or future internal organ fibrosis. Epidemiologically, there is evidence that fibrosis in one organ associates with fibrosis with another; the putative exposures that lead to fibrosis in diabetes (advanced glycation end product deposition, microvascular disease and hypoxia, persistent innate inflammation) are 'systemic'; a common genetic susceptibility to fibrosis has also been hinted at. These data suggest that a subset of the diabetic population is susceptible to multi-organ fibrosis. The hand is an attractive biomarker to clinically detect this susceptibility, owing to its accessibility to physical examination and exposure to repeated mechanical stresses. Testing the hypothesis has a few pre-requisites: being able to measure hand fibrosis in the hand, using clinical scores or imaging based scores, which will facilitate looking for associations with internal organ fibrosis using validated methodologies for each. Longitudinal studies would be essential in delineating fibrosis trajectories in those with hand manifestations. Since therapies reversing fibrosis are few, the onus lies on identification of a susceptible subset for preventative measures. If systematically validated, clinical hand examination could provide a low-cost, universally accessible and easily reproducible screening step in selecting patients for clinical trials for fibrosis in diabetes
A Tailored SMS Text Message-Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study.
No full textBackgroundHealth care providers are increasingly screening patients for unmet social needs (eg, food, housing, transportation, and social isolation) and referring patients to relevant community-based resources and social services. Patients' connection to referred services is often low, however, suggesting the need for additional support to facilitate engagement with resources. SMS text messaging presents an opportunity to address barriers related to contacting resources in an accessible, scalable, and low-cost manner.ObjectiveIn this multi-methods pilot study, we aim to develop an automated SMS text message-based intervention to promote patient connection to referred social needs resources within 2 weeks of the initial referral and to evaluate its feasibility and patient acceptability. This protocol describes the intervention, conceptual underpinnings, study design, and evaluation plan to provide a detailed illustration of how SMS technology can complement current social needs screening and referral practice patterns without disrupting care.MethodsFor this pilot prospective cohort study, this SMS text message-based intervention augments an existing social needs screening, referral, and navigation program at a federally qualified health center. Patients who received at least one referral for any identified unmet social need are sent 2 rounds of SMS messages over 2 weeks. The first round consists of 5-10 messages that deliver descriptions of and contact information for the referred resources. The second round consists of 2 messages that offer a brief reminder to contact the resources. Participants will evaluate the intervention via a survey and a semistructured interview, informed by an adapted technology acceptance model. Rapid qualitative and thematic analysis will be used to extract themes from the responses. Primary outcomes are implementation feasibility and patient acceptability. Secondary outcomes relate to intervention effectiveness: self-reported attempt to connect and successful connection to referred resources 2 weeks after the initial referral encounter.ResultsThe study received regulatory approval in May 2021, and we anticipate enrolling 15-20 participants for this initial pilot.ConclusionsThis protocol presents detailed implementation methods about a novel automated SMS intervention for social care integration within primary care. By sharing the study protocol early, we intend to facilitate the development and adoption of similar tools across different clinical settings, as more health care providers seek to address the unmet social needs of patients. Study findings will provide practical insights into the design and implementation of SMS text message-based interventions to improve social and medical care coordination.International registered report identifier (irrid)DERR1-10.2196/37316
Novel Method Using Baseline Normalization and Area Under the Curve to Evaluate Differences in Outcome Between Treatment Groups and Application to Patients With Cervical Spondylotic Myelopathy Undergoing Anterior Versus Posterior Surgery.
No full textRetrospective review of a prospective database.To describe a novel method that uses baseline normalization and area under the curve (AUC) to compare surgical outcomes between patients surgically treated anteriorly versus posteriorly for cervical spondylotic myelopathy (CSM).It is important to control for baseline characteristics, especially disease severity, when evaluating differences in outcomes between 2 treatment groups. However, current methods of reporting outcomes are limited perhaps diminish the health impact of the entire postoperative recovery experience.In the prospective, multicenter AO Spine North America CSM database, 147 patients had complete modified Japanese Orthopaedic Association (mJOA) data at baseline and at 6-, 12-, and 24-months postoperatively and were either treated anteriorly (n = 94) or posteriorly (n = 53). Each patient's follow-up mJOA scores were normalized by dividing them by the patient's baseline value. A graph was then plotted with the time point on the x-axis and the normalized score or "recovery index" on the y-axis. The AUC was calculated and then compared between the anterior and posterior surgical approach groups.The non-normalized recovery profile of the anterior group was better than that of the posterior group, as the patients treated anteriorly had less functional impairment at baseline. After normalization, patients in the anterior and posterior group had similar recovery indices and AUCs at 6-months following surgery. At 24-months, patients treated posteriorly had a significantly higher recovery index (1.32) and a larger AUC (16.3) than those treated anteriorly (1.11, 14.5, P = 0.004 and P = 0.006, respectively).This is the first study to apply AUC analysis to patients with CSM. In surgical patients with CSM, those treated anteriorly achieved a higher mJOA score at all time points than those treated posteriorly. The recovery indices, however, were not significantly different between approach groups at 6 months.3
Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis.
No full textBackgroundDespite reports showing positive long-term functional outcomes following adult spinal deformity (ASD)-corrective surgery, it is unclear which factors affect the durability of these outcomes.ObjectiveTo assess durability of functional gains following ASD-corrective surgery; determine predictors for postoperative loss of functionality.MethodsSurgical ASD patients > 18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, and 1-yr postoperative (1Y) ODI scores reaching substantial clinical benefit (SCB) threshold (SCB ResultsAll 166 included patients showed baseline to 1Y functional improvement (mean ODI: 35.3 ± 16.5-13.6 ± 9.2, P ConclusionSeventy-one percent of ASD patients maintained satisfactory functional outcomes by 3Y. Of those who failed to sustain functionality, the largest functional decline occurred 3-yr postoperatively. Frailty, preoperative comorbidities, and surgical approach affected durability of functional gains following surgery
Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning.
No full textBackgroundMandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint because it requires precise bone graft alignment, or alloplastic materials, for complete restoration of joint function. The use of computerized patient-specific surgical planning (CPSSP) technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the assistance of virtual surgery techniques.MethodsA retrospective review was performed to identify all patients who underwent mandibular reconstruction utilizing CPSSP with only a free fibula flap without any temporomandibular joint adjuncts after a hemimandibulectomy with total condylectomy.ResultsFrom 2018 to 2021, five patients underwent reconstruction of mandibular defects involving the condyle with CPSSP technology and preservation of the native temporomandibular articulating disk. The average age was 62 years (range, 44-73 years). The average follow-up period was 29.2 months (range, 9-46 months). Flap survival was 100% (N = 5). The maximal interincisal opening range for all patients was 22-45 mm with no lateral deviation or subjective joint pain. No patients experienced progressive joint hypomobility or condylar migration.ConclusionThe use of CPSSP technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intraoperative manipulation with optimal functional outcomes
RECOVERING THE ARCHITECTURAL PATRIMONY OF SOUTH ITALY: THE MEDIEVAL KINGDOM OF SICILY IMAGE DATABASE
No full textAltered white matter microstructural organization in posttraumatic stress disorder across 3047 adults: results from the PGC-ENIGMA PTSD consortium.
No full textA growing number of studies have examined alterations in white matter organization in people with posttraumatic stress disorder (PTSD) using diffusion MRI (dMRI), but the results have been mixed which may be partially due to relatively small sample sizes among studies. Altered structural connectivity may be both a neurobiological vulnerability for, and a result of, PTSD. In an effort to find reliable effects, we present a multi-cohort analysis of dMRI metrics across 3047 individuals from 28 cohorts currently participating in the PGC-ENIGMA PTSD working group (a joint partnership between the Psychiatric Genomics Consortium and the Enhancing NeuroImaging Genetics through Meta-Analysis consortium). Comparing regional white matter metrics across the full brain in 1426 individuals with PTSD and 1621 controls (2174 males/873 females) between ages 18-83, 92% of whom were trauma-exposed, we report associations between PTSD and disrupted white matter organization measured by lower fractional anisotropy (FA) in the tapetum region of the corpus callosum (Cohen's d = -0.11, p = 0.0055). The tapetum connects the left and right hippocampus, for which structure and function have been consistently implicated in PTSD. Results were consistent even after accounting for the effects of multiple potentially confounding variables: childhood trauma exposure, comorbid depression, history of traumatic brain injury, current alcohol abuse or dependence, and current use of psychotropic medications. Our results show that PTSD may be associated with alterations in the broader hippocampal network
Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy.
No full textObjectSagittal spinopelvic malalignment is a significant cause of pain and disability in patients with adult spinal deformity. Surgical correction of spinopelvic malalignment can result in compensatory changes in spinal alignment outside of the fused spinal segments. These compensatory changes, termed reciprocal changes, have been defined for thoracic and lumbar regions but not for the cervical spine. The object of this study was to evaluate postoperative reciprocal changes within the cervical spine following lumbar pedicle subtraction osteotomy (PSO).MethodsThis was a multicenter retrospective radiographic analysis of patients from International Spine Study Group centers. Inclusion criteria were as follows: adults (>18 years old) with spinal deformity treated using lumbar PSO, a preoperative C7-S1 plumb line greater than 5 cm, and availability of pre- and postoperative full-length standing radiographs.ResultsSeventy-five patients (60 women, mean age 59 years) were included. The lumbar PSO significantly improved sagittal alignment, including the C7-S1 plumb line, C7-T12 inclination, and pelvic tilt (p ConclusionsAdults with positive sagittal spinopelvic malalignment compensate with abnormally increased cervical lordosis in an effort to maintain horizontal gaze. Surgical correction of sagittal malalignment results in improvement of the abnormal cervical hyperlordosis through reciprocal changes