Degenerative Disease Patients Research Articles

Impact of Osteoporosis on Short-Term Surgical Outcomes in Lumbar Degenerative Disease Patients Undergoing Lateral Lumbar Interbody Fusion: A Retrospective Analysis

This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDDs), focusing on complications, pain intensity, and quality of life (QOL) improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively. A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into 2 groups based on osteoporosis status determined by dual-energy X-ray absorptiometry scans: those with osteoporosis (n= 20) and those without osteoporosis (n= 53). Data collection included demographics, surgical details, complications, magnetic resonance imaging analysis, pain intensity, and QOL (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire). The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in nonosteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status. Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and QOL improvements.

Decreased grip strength is associated with paraspinal muscular oxidative stress in female lumbar degenerative disease patients.

We aimed to investigate the relationship between superoxide dismutase 2-related oxidative stress in the paraspinal muscles and spinal alignment, clinical skeletal muscle parameters, and mitochondrial function. Multifidus muscle samples from patients who underwent posterior lumbar surgery were analyzed. Patients with diseases affecting oxidative stress and spinal alignment were excluded. The superoxide dismutase 2 redox index was defined as the ratio of reactive oxygen species (superoxide) to antioxidant enzymes (superoxide dismutase 2) and was used as an index of oxidative stress. Patients were divided into two groups based on the superoxide dismutase 2 redox index. Spinal alignment, clinical skeletal muscle parameters, and succinic dehydrogenase (SDH) mean grayscale value were compared between the groups, with analyzes for both sexes. Multiple regression analyzes were used to adjust for the confounding effect of age on variables showing a significant difference between the two groups. Thirty-five patients with lumbar degenerative diseases were included. No significant differences were observed between the two groups for any of the parameters in males; however, females with a higher superoxide dismutase 2 redox index had greater lumbar lordosis, lower grip strength, and higher SDH mean grayscale value than those with a lower index. Multiple regression analyzes revealed that the superoxide dismutase 2 redox index was an independent explanatory variable for lumbar lordosis, grip strength, and SDH mean grayscale value in female patients. In conclusion, superoxide dismutase 2-related oxidative stress in the paraspinal muscles was associated with mitochondrial dysfunction and decreased grip strength in female lumbar degenerative disease patients.

278 Lateral Anterior Column Release in Short Construct... Is It Worth It?

INTRODUCTION: Adjacent Segment Disease (ASD) is a common complication after lumbar spinal fusions. Ways to reduce the rates for ASD are highly sought after mainly to avoid re-operation. METHODS: We conducted a retrospective cohort study that consisted of patients that underwent 1-2 level LLIF for degenerative spine disease from 2014-2020. Patients needed to have at least one year of follow-up and have postoperative standing x-rays. Preoperative demographics, perioperative surgical characteristics, and postoperative outcomes were recorded. RESULTS: 92 patients were included for analysis after inclusion criteria. Median follow-up period of 25 months. 54% F, 64 years of age, BMI 31. 11 patients (12%) developed ASD at a median follow up of 29 months. In the patients with ASD, 9 (82%) underwent anterior column release (ACR) with the placement of hyper-lordotic cages > 20 degrees. In our cohort of short construct LLIF ACR was done 9 patients (L3/4 (7 patients) and L4/5 (2 patients). In the univariate analysis we found that age-adjusted PI-LL mismatch (p < 0.003), the use of a hyperlordotic cage (p = 0.003), and ACR release (p < 0.001) were significantly associated with ASD. A multivariate logistic regression model was created and showed only that ACR was predictive for ASD (Odds Ratio: 69.1, 95% confidence interval: 10.71-446.3, p < 0.001). CONCLUSIONS: ACR was predictive for developing ASD in lumbar degenerative disease patients that undergo short-segment LLIF. While other factors may play a role, this was the predominant factor identified in our cohort with at least 10-fold increase risk. ACR is a powerful tool to be use in only spinal deformity. We recommend against ACR in short construct LLIF.

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature.

Metanalysis. Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.

Hounsfield Unit Values as an Adjunct Diagnostic Tool: Investigating Its Relationship with Bone Mineral Density and Vertebral Bone Quality in Lumbar Degenerative Disease Patients

With an increasing prevalence of osteoporosis due to demographic shifts, accurate diagnostic methods are vital, particularly before spinal surgeries. This research investigated the correlation between bone mineral density (BMD) T-scores of the lumbar spine and femoral neck, Hounsfield Unit (HU) values from computed tomography (CT), and vertebral bone quality (VBQ) scores from Magnetic Resonance Imaging (MRI) in patients with lumbar degenerative disease. We analyzed data from 100 patients with lumbar degenerative disease who underwent CT, dual-energy X-ray absorptiometry (DXA), and MRI between 2019 and 2023. HU values were measured individually from L1 to L4, while T-scores were obtained from DXA scans of the lumbar spine and the femoral neck. The VBQ scores were derived from T1-weighted MRIs. A notable association between the lumbar and femoral neck T-scores and HU values was found. The VBQ score had a faint correlation with HU values and lacked any with the T-score. Notably, the HU values derived via the Youden index and regression closely matched. Lumbar spine HU values related to T-scores of 85.6 and 84.4, and femoral neck T-scores of 98.9 and 103.6, with a low T-score at 98.9 and 104.6. This study underscores a strong correlation between BMD and HU values from CT scans in lumbar degenerative disease patients, suggesting the utility of HU measurements as an adjunct diagnostic tool for osteoporosis. However, the correlation with the VBQ score remains weak. Further multicenter studies are essential for more robust validation.

An Expanded Surgical Corridor of Oblique Lateral Interbody Fusion at L4-5: A Magnetic Resonance Imaging Study.

We introduced a new preoperative method, the "expanded surgical corridor," to evaluate the actual safety corridor, which may expand the possibility of performing oblique lateral interbody fusion (OLIF). Axial T2-weighted magnetic resonance images at the L4-5 disc level of 511 lumbar degenerative disease patients was evaluated. The distance between the medial edge of the left-sided psoas muscle and the major artery was measured as the conventional surgical corridor (CSc). The distance between the major vein and lumbar plexus was measured as the expanded surgical corridor (ESc). The mean CSc and ESc were 13.9 ± 8.20 and 37.43 ± 10.1 mm, respectively. No surgical corridor was found in 7.05% of CSc and 1.76% of ESc, small corridor ( ≤ 1 cm) was found in 27.40% of CSc and 0.59% of ESc, moderate corridor (1-2 cm) was found in 42.07% of CSc and 1.96% of ESc, and large corridor ( > 2 cm) was found in 23.48% of CSc and 95.69% of ESc. A total of 33.83% (45 of 133) of whom were preoperatively categorized as having a limited surgical corridor by conventional measurement, underwent OLIF L4-5 successfully. By using the ESc, only 2.35% were categorized as having a limited surgical corridor. The other 97.65% of the patients had an approachable corridor that could be successfully operated by experienced spine surgeons who employ meticulous surgical dissection and thorough understanding of the anatomical structures. The ESc may represent true accessibility to the disc space for OLIF, particularly at the L4-5 level.

A comparative and prospective study of surgical outcomes of cervical artificial disc to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease of cervical spine in a tertiary care center of Eastern India

Background: Cervical disc degeneration is known to be a primary cause of neck pain and neurologic symptoms and can cause significant morbidity. Degeneration can be related to radiculopathy or myelopathy due to compression of spinal nerves and/or spinal cord. Disc pathology may manifest clinically as localized and radicular pain, myelopathy, and spinal joint instability. If severe, such as in degenerative disc disease, infections, and trauma, surgical methods are indicated. Some studies reported that compared to anterior cervical discectomy and fusion (ACDF), cervical artificial disc (CAD) could provide better neurological outcomes and reduce the rate of adjacent segment degeneration, whereas other studies reported no difference between the two procedures. Aims and Objectives: The aim of this study was to compare surgical outcomes of CAD to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease in cervical spine. Materials and Methods: It was a comparative study with prospective design conducted among 40 symptomatic cervical disc degenerative disease patients (20 patients undergoing CAD and the remaining 20 anterior cervical discectomy and fusion) at the Department of Neurosurgery, Bangur Institute of Neurosciences, 1PGMER and SSKM Hospital, Kolkata, from January 2021 to December 2022. Respective surgical procedures were done. All patients were required to return for follow-up. Clinical and radiological evaluations were performed at 1 month, 3 months, 1 year, postoperatively, and last follow-up (more than 18 months). Clinical effectiveness was evaluated by the visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score (17 points system, 1994 revised edition), and neck disability index (NDI) score. Results: Improvement in NDI, VAS, and JOA index was found to be more in CAD as compared to ACDF group with a statistically significant difference as P&lt;0.05. Subsequent surgical intervention was reported among four subjects, out of which one belonged to the CAD group while the rest three to ACDF. Overall success was found to be more in the CAD group (75%) as compared to the ACDF group (55%), though no significant difference was revealed as P&gt;0.05. Conclusion: The findings of the present study support the superior longevity and better outcome of CDA, as compared with ACDF, with regard to need for subsequent surgical intervention and also support better improvement in symptoms in subsequent follow-up in patients undergoing CDA as compared to ACDF despite having comparable mean operative time and blood loss.

Baseline Frailty and Discharge to Advanced Care Facilities in Patients Undergoing Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Registry Analysis of 7153 Patient Cases Comparing the Risk Analysis Index to the 5-Factor Modified Frailty Index

To evaluate the impact of frailty, as measured by the 5-factor modified Frailty Index (mFI-5) and the Risk Analysis Index (RAI), on advanced care facility discharge (FD) in patients who underwent lumbar fusion for lumbar degenerative spine disease. The American College of Surgeons National Surgical Quality Improvement Program (2012-2020) was queried for adults (≥18years) undergoing lumbar fusion for lumbar degenerative disease. Descriptive statistics and univariate crosstabulation were used to assess baseline demographics, preoperative comorbidities, and postoperative outcomes. Receiver operating characteristic curve analysis was used to assess the discriminative threshold of the mFI-5 and RAI on FD within this population. The median patient age in this study cohort (N= 7153) was 56years and FD occurred in 7.3% of cases. Receiver operating characteristic curve analysis demonstrated that both the mFI-5 and the RAI accurately predicted FD (C-statistics: mFI-5: 0.627; RAI: 0.746). DeLong's test found that the RAI had superior discrimination when compared to the mFI-5 (P < 0.0001). RAI is a reliable predictor of FD in lumbar degenerative disease patients who underwent lumbar interbody fusion and demonstrated superior discrimination compared to the mFI-5. Identification of patients at risk for FD may facilitate more precise risk stratification to enable better preoperative decision-making and help set more realistic expectations of care.

Does Preoperative Modic Changes Influence the Short-term Fusion Rate of Single Level Transforaminal Lumbar Interbody Fusion?-a Matched-pair Case Control Study.

At present, the influence of Modic changes (MCs) on postoperative fusion rate of lumbar interbody fusion (LIF) is mainly focused on the medium- and long-term fusion rate, while the short-term fusion rate has not been reported. The aim of this study was to compare the short-term fusion rate of lumbar degenerative disease patients with and without MCs after single level transforaminal lumbar interbody fusion (TLIF). In this retrospective and matched-pair case control study, we included 100 patients who underwent TLIF from January 2017 to January 2020 and had at least two follow-up visits over a two-year period. Fifty patients with MCs (MCs group) were matched with 50 patients without MCs (non MCs group) for age, sex, surgical level, diagnosis, operative time, and intraoperative blood loss. We collected the X-ray and computed tomography (CT) data of patients from 3 months to 2 years after the operation to assess bony fusion and the cage union ratio. According to the type of cage, the MCs group was further divided into the nano-hydroxyapatite/polyamide 66 (n-HA/PA66) group and polyetheretherketone (PEEK) group, and the fusion performance between the two groups was compared. Finally, age, sex, body mass index (BMI), smoking and cage type were included in the logistic regression model for risk factor analysis. The bony fusion rates in the MCs group at 3 months, 6 months, 1 year and 2 years after surgery were significantly lower than those in the non MCs group (P < 0.05) (23.8% vs 62.5%, 52.6% vs 78.9%, 61.1% vs 83.3%, 74.0% vs 90.0%). The average coronal cage union ratios of the upper and lower endplates in the MCs group were significantly lower than those in the non MCs group (54.3% ± 17.5% vs 75.0% ± 17.2%, P < 0.05; 73.3% ± 12.0% vs 84.9% ± 8.0%, P < 0.05). Similarly, analogous results were obtained by comparing the MCs and non MCs groups' three-dimensional CT sagittal plane images (62.5% ± 16.5% vs 76.1% ± 12.4%, P < 0.05; 67.0% ± 13.9% vs 79.8% ± 11.5%, P < 0.05). Short-term fusion rates were lower in the MCs group than in the non MCs group. The coronal and sagittal cage union ratio in the MCs group was lower than that in the non MCs group. The fusion performance of n-HA/PA66 and PEEK cages in the MCs group was comparable.

Unilateral biportal endoscopic spine surgery for lumbar spinal stenosis: a systematic review and meta-analysis.

Lumbar spinal stenosis is the most common spinal degenerative disease in patients over 60 years, and the unilateral biportal endoscopic (UBE) spine surgery treatment of lumbar spinal stenosis (LSS) has achieved preliminary clinical results. This systematic review and meta-analysis aimed to reveal the clinical efficacy of UBE for LSS and provide evidence for clinical practice. PubMed, Embase, Web of Science, and Cochrane databases were searched for literature. The papers selected were those published from inception till October 2021. The selected pieces of literature were graded for evidence using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Outcomes measures were operation time, blood loss, complication rate, admission period, Visual Analogue Scale (VAS)-back, VAS-leg, and Oswestry Disability Index (ODI) score, and radiological outcomes. The mean comparisons were based on VAS and ODI scores. A total of 823 patients with a single LSS segment were included from the selected nine studies. There were nine studies comparing UBE clinical outcomes and micro-endoscopic unilateral laminotomy for bilateral decompression (M-ULBD). The meta-analysis revealed that the UBE group had better VAS-leg and -back scores in the first week postoperatively [total: mean difference (MD) = -0.96, 95% confidence interval (CI): -1.19, -0.74, p < 0.00001; total: MD = -1.69, 95% CI: -1.93, -1.45, p < 0.00001], 1st month postoperatively (total: MD = -0.35, 95% CI: -0.61, -0.08, p = 0.01; total: MD = -0.40, 95% CI: -0.68, -0.12, p = 0.005), 6th month postoperatively (total: MD = -0.22, 95% CI: -0.35, -0.08, p = 0.002; total: MD = -0.24, 95% CI: -0.40, -0.07, p = 0.005), and UBE group also performed better in ODI score at 1st month postoperatively (total: MD = -3.36, 95% CI: -4.26, -2.46, p < 0.00001). There was no significant difference in VAS-leg and -back scores between both groups at the 3rd and 12th month postoperatively, and ODI scores did not significantly differ between both groups at 3, 6, and 12 months postoperatively (all p > 0.05). UBE has achieved good preliminary clinical results and may be a minimally invasive alternative surgery for patients with single segmental LSS.

Incidences, causes and risk factors of unplanned reoperation within 30days of craniovertebral junction surgery: a single-center experience.

To investigate the incidences, causes, and risk factors for unplanned reoperation within 30days of craniovertebral junction (CVJ) surgery. From January 2002 to December 2018, a retrospective analysis of patients who underwent CVJ surgery at our institution was conducted. The demographics, history of the disease, medical diagnosis, approach and type of operation, surgery duration, blood loss, and complications were recorded. Patients were divided into the no-reoperation group and the unplanned reoperations group. Comparison between two groups in noted parameters was analyzed to identify the prevalence and risk factors of unplanned revision and a binary logistic regression was performed to confirm the risk factors. Of 2149 patients included, 34(1.58%) required unplanned reoperation after the initial surgery. The causes for unplanned reoperation contained wound infection, neurologic deficit, improper screw placement, internal fixation loosens, dysphagia, cerebrospinal fluid leakage, and posterior fossa epidural hematomas. No statistical difference was found in demographics between two groups (P > 0.05). The incidence of reoperation of OCF was significantly higher than that of posterior C1-2 fusion (P = 0.002). In terms of diagnosis, the reoperation rate of CVJ tumor patients was significantly higher than that of malformation patients, degenerative disease patients, trauma patients, and other patients (P = 0.043). The binary logistic regression confirmed that different disease, fusion segment (posterior) and surgery time were independent risk factors. The unplanned reoperation rate of CVJ surgery was 1.58% and the major causes were implant-related failures and wound infection. Patients with posterior occipitocervical fusion or diagnosed with CVJ tumors had an increased risk of unplanned reoperation.

Requirement of transcription-coupled nucleotide excision repair for the removal of a specific type of oxidatively induced DNA damage.

Accumulation of DNA damage resulting from reactive oxygen species was proposed to cause neurological and degenerative disease in patients, deficient in nucleotide excision repair (NER) or its transcription-coupled subpathway (TC-NER). Here, we assessed the requirement of TC-NER for the repair of specific types of oxidatively generated DNA modifications. We incorporated synthetic 5',8-cyclo-2'-deoxypurine nucleotides (cyclo-dA, cyclo-dG) and thymine glycol (Tg) into an EGFP reporter gene to measure transcription-blocking potentials of these modifications in human cells. Using null mutants, we further identified the relevant DNA repair components by a host cell reactivation approach. The results indicated that NTHL1-initiated base excision repair is by far the most efficient pathway for Tg. Moreover, Tg was efficiently bypassed during transcription, which effectively rules out TC-NER as an alternative repair mechanism. In a sharp contrast, both cyclopurine lesions robustly blocked transcription and were repaired by NER, wherein the specific TC-NER components CSB/ERCC6 and CSA/ERCC8 were as essential as XPA. Instead, repair of classical NER substrates, cyclobutane pyrimidine dimer and N-(deoxyguanosin-8-yl)-2-acetylaminofluorene, occurred even when TC-NER was disrupted. The strict requirement of TC-NER highlights cyclo-dA and cyclo-dG as candidate damage types, accountable for cytotoxic and degenerative responses in individuals affected by genetic defects in this pathway.

Cone-beam computed tomographic characteristics in degenerative temporomandibular joint disease patients with chewing side preference

This study is aimed at assessing the Cone-beam computed tomographic (CBCT) characteristics of temporomandibular joints (TMJ) in degenerative temporomandibular joint disease (DJD) patients with chewing side preference (CSP). CBCT images of 98 patients with DJD (67 with CSP and 31 without CSP) and 22 asymptomatic participants without DJD were measured retrospectively to compare the osteoarthritic changes and the morphology of TMJ. Quantitative analysis of the TMJ radiographic images was performed to present a comparison between the three inter-group groups and between the two sides of the joints. The frequencies of the articular flattening and surface erosion occur more often in the preferred side joints of DJD patients with CSP than the contralateral side. In addition, the horizontal angle of condyle, the depth of glenoid fossa (DGF), and the inclination of articular eminence (IAE) were larger in DJD patients with CSP than that in asymptomatic participants (p<0.05). Also, the condylar anteroposterior dimension of preferred side joints was significantly less than that of non-preferred side (p=0.026), while the width of condyles (p=0.041) and IAE (p=0.045) was greater. DJD patients with CSP appear to have a higher prevalence of osteoarthritic changes, with the morphological changes such as flat condyle, deep glenoid fossa, and steep articular eminence, which might be considered the characteristic imaging features. This study found that CSP is a predisposing factor for the development of DJD, and attention should be paid to the existence of CSP in DJD patients during the clinical practice.

The Analysis of Preoperative Roussouly Classification on Pain Scores and Radiological Data in Lateral Lumbar Interbody Fusion for Patients with Lumbar Degenerative Disease

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of patients with lumbar degenerative disease who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into 4 groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial magnetic resonance imaging were smaller than those in the standard group. On the other hand, each numeric rating scale score 1year after surgery improved in all patients. Changes in numeric rating scale scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement.

Percutaneous Transforaminal Endoscopic Surgery (PTES) for Treatment of Lumbar Degenerative Disease in Patients with Underlying Diseases: A Retrospective Cohort Study of 196 Cases.

To evaluate the postoperative outcomes, safety and feasibility of percutaneous transforaminal endoscopic surgery (PTES) for the treatment of lumbar degenerative disease (LDD) in the patients with underlying diseases. From June 2017 to April 2019, PTES was performed to treat 226 patients of single-level LDD. According to clinical background, the patients were divided into two groups. A total of 102 patients with underlying diseases were included in group A. The other 124 LDD patients without underlying diseases were included in group B. The occurrence of postoperative complications was recorded. Leg pain was assessed before, immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after PTES using VAS, and ODI before PTES and 2 years after PTES were recorded. The therapeutic quality (Excellent, Good, Moderate or Poor) was defined according to MacNab grade at 2-year follow-up. No aggravation of underlying diseases or serious complications was observed in all patients within 6 months after the operation. Altogether, 196 patients were followed up for more than 2 years, 89 patients in group A and 107 patients in group B. The VAS score of leg pain and ODI dropped significantly after surgery (P<0.001) in both groups. One case of group B received PTES again due to recurrence 52 months after surgery. According to MacNab, the excellent and good rate was 97.75% (87/89) in group A and 96.26% (103/107) in group B. In operative duration, frequency of intraoperative fluoroscopy, blood loss, incision length, hospital stay, VAS, ODI, and the excellent and good rate, there was no statistical difference between the two groups. PTES is safe, effective and feasible for the treatment of LDD with underlying diseases, which is comparable to PTES for LDD without underlying diseases. The entrance point of PTES (Gu's Point) is located at the corner of the flat back turning to the lateral side. PTES is not only a minimally invasive surgical technique but also includes a postoperative care system for preventing LDD recurrence.

Text Network-Based Method for Measuring Hand Functions in Degenerative Brain Disease Patients

In this study, we collected various past study results on tools and analytical methods for measuring hand functions of patients with degenerative brain diseases, such as Parkinson’s disease and stroke, and selected and proposed appropriate hand function measurement tools, methods, and analysis software based on text network analysis. We searched the literatures using keywords related to degenerative brain disease and stroke patients for participant types, use of devices and sensors for the intervention types, and hand function assessment for measurement types. Among the 2484 literatures collected, 19 were eventually selected based on certain inclusion and exclusion criteria. As a result of text network analysis, the degree-centrality and the betweenness centrality were the highest in the keyword of Parkinson’s disease for the participant type, force sensor for the intervention type, and finger tapping for the measurement type. Based on these results, pinch gloves comprising an FSR sensor were manufactured, and software and contents were implemented to measure and analyze various quantitative parameter values during finger tapping. The software can evaluate endurance and agility by measuring the finger-tapping intensity and operation time using the index finger and thumb. The contents can evaluate the stability of hand functions by analyzing the coefficient of variation of the tapping interval, the average contact time, and the accuracy of hand functions by analyzing the reaction rate to the presented visual stimulus. As a result of comparing hand functions through 10 types of analysis parameters with a sample of 12 ordinary subjects (8 men and 4 women) using the manufactured pinch gloves, there was a difference between the two genders in the items evaluating muscle strength and agility, and a significant difference in the analysis parameters evaluating stability and accuracy. The results indicate that using the text network analysis-based hand function measurement tool and the method proposed in this study should help derive the objective research results as well as a quantitative comparison of research results of various researchers.

Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study

BACKGROUND CONTEXTThe theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial. PURPOSEThe present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center. STUDY DESIGNThis was a propensity-score matched cohort study. PATIENT SAMPLEThis study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups. OUTCOME MEASURESThe outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications. METHODSNDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method. RESULTSThe average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%). CONCLUSIONSThrough nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.

Prevalence of Asymptomatic Deep Vein Thrombosis in Preoperative State of Spine Surgeries

Deep venous thrombosis (DVT) is considered the most common cause of preventable death among hospitalized patients. A few studies have investigated the risk of venous thromboembolic events (VTE) in patients undergoing elective spine surgery and reported varying incidences. We aim to assess the incidence of preoperative lower limb DVT in lumbar degenerative disease patients undergoing elective surgery. This is a retrospective review of prospectively collected data on adult patients with lumbar degenerative spine diseases (lumbar stenosis; LST, lumbar spondylolisthesis; SPL, or lumbar disc herniation; LDH) who were scheduled for operative management. Each patient underwent a preoperative lower limb venous Duplex (LLVD). Incidence of DVT, risk factors, and clinical course of patients were reported. Forty-nine patients (32 females; 65%) were included. All patients were diagnosed clinically and radiologically with lumbar degenerative diseases; LST (44.9%), SPL (36.7%), and LDH (18.4%), requiring surgical management. Three patients (6.1%) were found to have positive DVT studies, leading to the cancellation or rescheduling of their procedures (p < 0.01). These included one patient with LST (p = 0.045) and two patients with SPL (p = 0.006). Among patients with LST and SPL, higher disability (modified Rankin scale; mRS ≥3) was significantly associated with positive LLVD (p = 0.035). Patients with LST or SPL with higher preoperative disability scores were at higher risk to have preoperative DVT. Further research is needed to evaluate the feasibility and value of preoperative LLVD to detect DVT in patients planned for lumbar degenerative surgery.

Comparison of Posterior Pedicle Screw Fixation and Lateral Fixation in the Extreme Lateral Interbody Fusion in Lumbar Degenerative Disease Patients with Osteopenia or Osteoporosis.

Nowadays, with the increasing proportion of osteoporosis in patients with lumbar degenerative diseases, doctors are facing the choice of intraoperative internal fixation methods. The purpose of this study was to compare and assess the clinical results of posterior bilateral pedicle screw fixation and lateral fixation in the extreme lateral interbody fusion (XLIF) in patients with osteopenia or osteoporosis. The retrospective review was performed on 67 degenerative lumbar diseases patients with osteopenia or osteoporosis who underwent XLIF in our hospital from January 2018 to July 2021. Patients in this study were classified into lateral screw (LS) group, lateral self-locking plate (LP) group, and bilateral pedicle screw (BPS) group. The functional evaluation factors containing Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of leg pain, and VAS of low back pain, radiological factors such as disc height (DH), lumbar lordotic (LL) angle, segmental lordotic (SL) angle, cage subsidence degree and interbody fusion degree were compared. Primary outcomes: no differences were observed with regards to the incidence of complications among LS, LP and BS group (P < 0.05). The JOA and leg pain VAS were significantly improved after operation (P < 0.05) and all groups demonstrated similar improvements in the leg pain VAS and JOA score (P > 0.05). When comparing VAS of leg pain and JOA scores, no differences were identified among LS, LP and BPS groups (P > 0.05). There are four thigh sensory complaint, one hip flexor weakness and one thigh pain occurred and no death was observed. There were significantly better DH, LL angle, SL angle, cage subsidence degree and interbody fusion degree in the BPS group than in LS and LP groups 1 year after surgery (P < 0.05). The DH loss ratio, LL angle loss ratio, SL angle loss ratio in the BPS group was significantly lower than in the LP and LS groups (P < 0.05). The 12-month SL angle improvement rate in the BPS group was significantly higher than in the LP and LS groups (20.20± 14.69, 0.73 ± 4.68, 6.20 ± 12.31, P < 0.05). the BPS patients had significantly worse intraoperative blood loss and operation time than LS and LP patients (P < 0.05). In lumbar diseases patients with osteopenia or osteoporosis, the bilateral pedicle screw fixation has better orthopedic effect than lateral internal fixation, and can better maintain the stability of the spine in the long-term follow-up, which is a better choice in XLIF surgery.

Knowledge-Based Remote E-Coaching Framework Using IoT Devices for In-Home ADL Rehabilitation Treatment of Degenerative Brain Disease Patients

The activities of daily living (ADL) ability level of an elderly patient is an important indicator in determining the patient’s degree of degenerative brain disease and is mainly evaluated through face-to-face interviews with doctors and patients in hospitals. It is impossible to determine the exact ADL ability of a patient through such a temporary interview, and the pursuit of accurate ADL ability evaluation technology is a very important research task worldwide. In this paper, in order to overcome the limitations of the existing ADL evaluation method mentioned above, first of all, a self-organized IoT architecture in which IoT devices autonomously and non-invasively measure a patient’s ADL ability within the context of the patient’s daily living place was designed and implemented. Second, a remote rehabilitation treatment concept for enhancing the patient’s ADL ability we call an “e-coaching framework”, in which a doctor remotely gives an instruction in a specific ADL scenario, and the patient’s ability to understand and perform the instruction can be measured on-line and in real time, was additionally developed on top of the self-organized IoT architecture. In order to verify the possibility of remote rehabilitation treatment through the proposed architecture, various remotely directed ADL scenarios were performed and the accuracy of the measurements was verified.