Independent Doctors Research Articles

The Dorsomedian Ligamentous Strand: An Evaluation In Vivo with Epiduroscopy.

Several anatomical studies have described the morphology of the spinal space; however, researchers do not all agree on the presence of the dorsomedian ligamentous strand (DLS), which divides the epidural space. The possible existence of this structure still influences some clinical practice, such as locoregional anesthesia and pain therapy. Since the number of procedures occurring inside the epidural space have increased, this study’s primary objective was to describe the composition of this space through epiduroscopy. We conducted a retrospective analysis of video recorded during epiduroscopy. Two independent doctors performed blind analyses of morphological aspects of peridural space visualized during the procedure in each patient for the maximum possible extension depending on the underlying pathology in the tract from S1 to L1. We enrolled 106 patients who underwent epiduroscopy; 100% of patients presented no medial longitudinal segmentation dividing the epidural channel at any level of the spinal tract investigated, including in the epidural space with pathological fibrotic scars and in those with no adherence. The main finding of our study was the visual absence of any anatomical structure dividing the epidural channel. We report that in vivo, in our experience, with direct epiduroscopy, the DLS is not visible.

New method to evaluate sequelae of static facial asymmetry in patients with facial palsy using three-dimensional scanning analysis

ObjectiveDuring the process of neural recovery after facial palsy, distressing sequelae of static and dynamic facial asymmetry develop in patients with facial palsy. A pronounced nasolabial fold is mainly responsible for static facial asymmetry, which leads to many psychological and social problems in patients. Objective and qualitative assessment of facial appearance is critical to determine the severity of sequelae of static facial asymmetry and whether an intervention is effective for treatment. In the present study, an attempt was made to develop three-dimensional analysis method to assess sequelae of static facial asymmetry after facial palsy. MethodsEight patients with sequelae of facial asymmetry after facial palsy and ten healthy volunteers were enrolled. We used three-dimensional scanning analysis with a portable non-contact optical scanner to obtain three-dimensional surface data from a patient's face and produced a three-dimensional digital model of the face. We then identified a reference plane fixed with the patient's face, and measured the depth of the nasolabial fold of the face. ResultsThe nasolabial fold of the face on the affected side was significantly deeper than that on the unaffected side in patients with sequelae of static facial asymmetry after facial palsy. However, the depth of the facial nasolabial fold on the right side was not different from that on the left side in healthy volunteers. Affected-unaffected side differences in the depth of the nasolabial fold in patients with sequelae of static facial asymmetry after facial palsy were significantly larger than left-right differences in the depth of the nasolabial fold in healthy volunteers. Two weeks after treatment with botulinum toxin injection to the affected zygomaticus muscles, affected-unaffected side differences in the depth of the nasolabial fold were significantly decreased in the patients. In the patients who received botulinum toxin, the absolute values of affected-unaffected side differences in the depth of the nasolabial fold measured using the three-dimensional scanning analysis showed a significant positive correlation with the visual analog scale scores of facial asymmetry marked by independent doctors. ConclusionThe present findings suggest that affected-unaffected side differences in the depth of the nasolabial fold of the measured using three-dimensional scanning analysis can be used as an index of sequelae of static facial asymmetry. It is also suggested that the index can evaluate whether interventions are effective for the treatment of sequelae.

The personalized Berger method is usable to solve the problem of tibial rotation

PurposeThe revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case.MethodsPreoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks.The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated.ResultsA very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°).ConclusionThe method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component.Level of evidenceLevel II, Diagnostic Study (Methodological Study).

Correlation between hand functioning, cognition and quality of life of CP children: 2-year prospective randomized study

IntroductionFor treatment of CP patients multidisciplinary approach is often promoted. But it is not cost-efficient to involve all medical staff and variety of diagnostic/intervention tools for every patient.ObjectivesHaving knowledge on pivotal manifestations of CP and what are they related to would ease multidirectional approach in practice. It will shorten a search of pathologies only to those related to main manifestations related to quality of life.Methods611 children aged 2 to 18 years (mean age–6y5m) with CP(G80.0-G80.9): examined by 3 independent doctors. 56%males, 44%females. Randomized blinded assessment. Fine hand function assessed by “9-hole peg”,“Box and Blocks” tests, dynamometry. Intellectual functioning assessment was done using Raven Matrices. Quality of Life(QoL) assessment according to Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). The intraclass correlation coefficient(ICC) was used for finding out discrepancies between observers. Inferencial statistics including 95%CI and P-value.ResultsICC coefficient between observers was highly reliable–0.93(95%CI:0.89–0.95). The mean QoL score for children GMFCS levels I and II was 58.5(SD 16.6), for GMFCS III, IV and V children–22.4(SD13.4). QoL was more related to fine hand functioning(r=0,344) than to cognition(r=0,295). There was a strong correlation bond between fine hand functioning and cognition (r=0,663). In case fine hand function improved positive changes in cognition were observed in 74% of subjects(p<0,05). Correlation between grasp power and IQ was weak(r=0,184). Grasp power improvement was slightly related to QoL(r=0,102).ConclusionsFine hand functioning improves QoL even more that cognition.So training of fine motor skills should be given a priority in case of limited rehabilitation resources.DisclosureNo significant relationships.

A Validated Photonumeric Scale for the Evaluation of Neck Skin Laxity.

Neck aging is usually evaluated together with the lower face. To date, a skin laxity scale for the neck as an independent anatomical district is lacking. To create and validate a proposed photonumeric neck skin laxity (NSL) scale. Frontal neck photographic images of 110 subjects were collected. Each standardized neck image was evaluated twice by 3 independent doctors, 1 week apart. A 4-point photonumeric NSL scale was developed (0 = absence of skin laxity and 4 = severe skin laxity) and validated in terms of intraobserver and interobserver correlation and internal consistency. The intraobserver reliability analysis of the 2 assessments performed by each observer revealed excellent correlation and consistency of the severity grading, independently of the time of evaluation (from 0.96 to 0.99, p < .01). Furthermore, the interobserver reliability analysis revealed an excellent agreement between the evaluators and an internal consistency independent of the evaluator (0.97, p < .01). The newly developed NSL scale is a reliable and reproducible scoring system for the aesthetic evaluation of skin laxity of the neck.

Impacto prognóstico das complicações ocorridas durante o transporte de crianças gravemente doentes

Objetivo: o transporte de crianças gravemente doentes envolve particularidades que aumentam o risco de complicações. O objetivo foi investigar o impacto de complicações registradas durante o transporte na mortalidade geral e na taxa de alta hospitalar.Método: estudo realizado em duas etapas. A primeira foi um estudo transversal, no qual, através de entrevista padronizada, dirigida ao médico que admitiu essas crianças, foram identificadas potenciais complicações ocorridas durante o transporte. Três médicos independentes auditaram esses dados. A segunda etapa foi uma coorte prospectiva onde os pacientes divididos em dois grupos (com e sem complicações no transporte) foram seguidos prospectivamente.Resultados: 143 crianças foram incluídas no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 delas (52%). A complicação mais prevalente foi relacionada a falhas no monitoramento e nos dispositivos (42%). A ocorrência de complicações no transporte foi associada a maior mortalidade hospitalar (Hazard ratio - HR): 5,60; intervalo de confiança de 95% (IC95%): 1,26 - 26,65; p=0,013) e a menor taxa de alta hospitalar (HR: 0,48; IC95%: 0,31 - 0,74; p = 0,0007). Após regressão de Cox para ajuste de fatores de confusão, a presença de complicações permaneceu associada à mortalidade hospitalar (HR: 6,74; IC95%: 1,40 - 32,34); p = 0,017), porém deixou de se associar com a taxa de alta hospitalar (HR: 0,76; IC95%: 0,49 - 1,16; p=0,213).Conclusão: presença de complicações durante o transporte pediátrico foi frequente na região metropolitana de Ribeirão Preto, São Paulo, Brasil. A ocorrência de complicações foi um preditor independente de mortalidade hospitalar.

Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia.

Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality. This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis. A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03-19.77; p=0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27-10.99; p=0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72-22.86; p=0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44-19.17; p=0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure. Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis.

P296 Quality of reporting of lesions detected at surveillance colonoscopy for IBD

Abstract Background International guidelines of ESGE and ASGE have laid out best practice for documentation of lesions at colonoscopy but few performance indicators have been proposed for surveillance colonoscopy in IBD. A recent publication has highlighted the key performance indicators for surveillance colonoscopy.1 We conducted an audit of current quality of colonoscopy reports documenting lesions detected during surveillance colonoscopy. Methods A retrospective analysis of patients who underwent colonoscopy for IBD surveillance over a five year period (2014–2019) at the Queen Elizabeth Hospital, Birmingham, UK was performed. The reports were analysed by independent academic doctors in the gastroenterology division trained in quality of endoscopic report analysis. Optimum criteria for documentation comprised lesion nature (Paris classification), size, documentation of Kudo classification and pit pattern, borders and ulceration. Results A total of 1028 colonoscopies were performed for IBD surveillance and the procedures were standardised with routine dye spraying since 2016. The mean patient age was 47.9 years (SD 16.8). Visual evidence of colonoscopic lesions was recorded in 273 cases. Key performance indicators documented for each endoscopic criterion and lesion nature is noted in the Table. Low-grade dysplasia was detected in 61 patients, and carcinoma in 4 patients; no patient had high-grade dysplasia. Benign lesions such as pseudopolyps were detected in the rest. 7 patients had sessile serrated lesions. Conclusion At IBD surveillance colonoscopy, documentation of lesions is better for the domains of size, Paris classification and Kudo pit pattern, though not perfect. We also highlight that our colonoscopic documentation of borders and presence of ulcerations is done poorly. It is important that comprehensive training is undertaken to improve documentation as it is essential for the proper choice of management of these lesions. Reference

Antibiotic prescription rate for upper respiratory tract infections in general practice - a Croatian study.

Aim Acute upper respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The frequency of antibiotics prescribed to patients with upper respiratory tract infections has been studied. Methods A cross-sectional survey has been conducted from October to December 2017 with participation of 17 General Practices in Croatia. Visits of patients with symptoms of upper respiratory tract infections made the survey framework. A specially structured questionnaire was a tool for the assessment of reasons for encounters, clinical statuses and practitioners' decisions. According to the registered clinical status, two independent doctors classified patients using Centor criteria, which were used to evaluate appropriate indication for antibiotic prescription. Results The survey analysed 709 patients' visits. Seventy three percent of general practice visits due to acute respiratory tract infection were initial. Antibiotics had been prescribed in the total of 32.6% of cases. Analysing upper respiratory tract infections with Centor score 1 and 2, antibiotics had been prescribed in 22.8% cases of the first visit and in 31.7% of the second visit, and with the Centor score 3 and 4 antibiotics had been prescribed in 85.1% of cases during the initial visit, and 66.7% of cases during the second visit. Logistic regression analysis about the contribution of nonclinical variables to antibiotic prescribing showed that most often antibiotics had been prescribed on Mondays. The most prescribed group of antibiotics was the penicillin group (74.8%), followed by macrolides (17.6%) and cephalosporins (4.0%). Conclusion General practitioners prescribe antibiotics for acute respiratory tract infections more than recommended by evidence based medicine and professional criteria.

Tuberculosis Treatment with DOTS Strategy on Mandiri Practice Doctor as Public Private Mix a Case Study in Kebumen Regency

Background: Tuberculosis or TB is still a public health problem that poses a global challenge. The spread of this disease through droplets of people who have been infected with tuberculosis bacilli. The incidence of TB transmission is around 5-15%. The TB Control Program in a national strategy is directed toward universal access to quality TB services, this can be achieved by involving all health-care facilities. Public-Private Mix / PPM (the collaboration between government services and private services) is the inclusion of all health service facilities in an effort to expand TB services and TB program continuity with a comprehensive approach. Uncomplicated management of pulmonary tuberculosis must be resolved by doctors who work in health centers/clinics from starting to make clinical diagnoses to managing the disease independently and thoroughly.Objectives: This research is to find out the implementation, obstacles to the implementation of DOTS strategy TB treatment at an independent practice physician in Kebumen Regency, and the form of a collaborative pattern of DOTS strategy TB treatment between independent practice doctors and health centers as a form of collaboration in Public-Private Mix.Methods: This research is a case study with a qualitative descriptive approach. Samples were taken by purposive sampling from puskesmas and health department. The total sample of 25 respondents consisted of 4 independent practice doctors, and from the puskesmas consisted of 5 puskesmas heads, 5 TB officers, 5 TB management officers, 3 Health Office officials, and 3 TB patients. Results: Most independent doctors diagnose based on clinical symptoms of TB and a small portion supported by chest X-ray. All puskesmas have implemented TB management with the DOTS strategy, but the results of TB program achievements are still low. This is because the number of suspected TBs is still low. Puskesmas need networks to find TB suspects. One solution is to form a collaboration scheme between puskesmas and independent practice doctors to improve TB management.Conclusion: The mapping of the implementation and barriers of TB DOTS and the solution to the scheme are in the form of collaboration between puskesmas and independent doctors in the form of PPM (Public Private Mix).

PENGARUH LAMA PRAKTIK DAN PENGETAHUAN DOKTER PRAKTIK MANDIRI TERHADAP PENEMUAN TERDUGA TUBERCULOSIS ANAK DI WILAYAH SURABAYA UTARA

Indonesia is the second most populated country with TB in the world. The proportion of Tuberculosis (TB) and adult tuberculosis cases in Indonesia is increasing every year. East Java is ranked second in TB cases in Indonesia. Surabaya is the most common city of TB cases. Therefore, WHO recommends the DOTS program for TB control that focuses on finding and healing TB patients, especially TB children. However, the implementation of this program has an imbalance in the number of adult TB findings and child TB. Factors that influence the discovery of TB suspected children are the length of practice and knowledge of Independent Practice Doctors (DPM). The purpose of this study was to analyze the effect of long time practice and knowledge of Practice Doctor Mandiri on TB child suspected finding. This research is an umbrella research of operational research of child TB treatment network with cross sectional study design. The sampling technique is simple random sampling with the amount of 42 people. Data collection is secondary data using data collection sheets. Data analysis using logistic regression. The result shows that there is a long effect of practice on TB children with p value 0,015 &lt;0,05 and OR value is 8,182. Independent Practice Physician Knowledge has no effect on TB children with p value 0,297&gt; 0,05 and OR 2,125. There is a need for regular socialization of child TB, especially the management of child TB and the commitment of the Independent Practice Doctor to the discovery of TB suspected

What advice should we give to patients about their consultation?

As doctors we are constantly striving to improve our consultation skills, to get the most out of our precious 10 minutes with our patient. But who is providing our patients with feedback on their consultation style? Can we support our clients to be better patients? In a survey in January 2018 using social media, I asked (on behalf of my blog teachmegp.com) a group of 5956 GPs and GP trainees: ‘What advice would you give your patients about improving their GP appointment?’ The answers were in the form of free text. We discovered 34 different recommendations for patients about their 10-minute consultation. This article reports only suggestions that were made by at least two independent doctors. Recommendations from …

Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine: A Cross-Sectional Observation Study.

To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome (BSS) patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine (DKMs) determined the diagnosis of BSS or non-BSS based on the subjects signs and symptoms. The scores assigned to BSS symptoms and DKMs' reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. A total of 169 of 204 (82.8%) patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4% (92 cases) were diagnosed with BSS, and 45.6% (77 cases) were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases (54.4%) of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

Workload implications of the proposed new Mental Health Act — an audit

AIMS AND METHOD To estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government9s white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated. RESULTS The amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected. CLINICAL IMPLICATIONS If the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time — or other services for patients will suffer.

Effectiveness of various non-steroidal anti-inflammatory drugs in pain management of patients with vertebral fracture: A comparative clinical study

Purpose: To study the effectiveness of various nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with vertebral fractures. Methods: A total of 78 patients (17 males and 61 females) with a mean age of 69.5 years were included. The major inclusion criterion was an osteoporotic vertebral fracture between T7 and L3. The exclusion criteria included fractures above T7 and below L3; and other bone disorders such as disc herniation, spondylolisthesis, an infection, or a tumour. Pain intensity was assessed with the aid of a 10-point visual analogue scale (VAS). Bone mineral density (BMD) data, delay in reunion, and any other matter of significance, were discussed with the treating doctors and cross-checked with independent doctors. The NSAIDs given were non-selective cyclo-oxygenase (COX) inhibitors (naproxen, indomethacin and flurbiprofen) and selective COX 2 inhibitors (piroxicam, celecoxib, and rofecoxib). All data were compiled and appropriately analysed. Results: Some NSAIDs interfered with bone healing. No male required surgery, but two females taking naproxen, one taking flurbiprofen, and another taking celecoxib, required surgery. In terms of bone healing, non-union and delay in reunion were more evident in those taking naproxen, indomethacin or flurbiprofen than in those taking piroxicam, celecoxib, or rofecoxib. All T scores were lower than -2.5, indicating that all the patients were osteoporotic. Positive changes in T scores after 12 weeks were evident only in those taking rofecoxib, celecoxib, or piroxicam. VAS scores were also better in these patients. Conclusions: Celecoxib seems to be the best of the six NSAIDs in terms of both analgesia and bone health. The study recommends the use of celecoxib in patients with vertebral fractures. Keywords: Orthopaedic, NSAID, COX, Bone reunion, Analgesic activity, Pain management, T score

The value of tap test for intraoperative diagnosis of the acute deltoid ligament injury

Objective To explore the value of the tap test for intraoperative assessment of the integrity of deltoid ligament. Methods Sixty-two consecutive patients who were suspected to have a combined deltoid ligament injury between March 2013 and August 2015 were enrolled in this prospective study. Gravity stress test was performed on those 62 cases preoperatively by three independent doctors. The diagnosis that at least two doctors agreed with was defined as a final result. After open reduction and internal fixation of fibular and posterior malleolus fracture, tap test was performed to evaluate the integrity of deltoid ligament intraoperatively. The sensitivity, specificity, positive predict value, negative predict value, false positive rate and false negative rate were calculated. The Kappa coefficient was used to determine inter-rater reliability. Results Among the 62 cases, gravity stress test before the surgery demonstrated that 47 (75.8%) of the 62 patients had a positive result, while tap test showed 52 (83.9%) cases got a positive result. Finally 48 (77.4%) cases were proved to be combined with deltoid ligament rupture by surgical exploration. Tap test had a sensitivity of 100%(48/48), a specificity of 71.4%(10/14), a positive predict value of 92.3%(48/52), a negative predict value of 100%(10/10), a false positive rate of 28.6%(4/14) and a false negative rate of zero(0/48), while gravity stress test had a sensitivity of 95.8%(46/48), a specificity of 92.9%(13/14), a positive predict value of 97.9%(46/47), a negative predict value of 86.7%(13/15), a false positive rate of 7.1%(1/14) and a false negative rate of 4.2%(2/48). The consistency between the observers and kappa coefficient of both tests were above 90% and 0.75. Conclusion Both tap test and gravity stress test had excellent inter-rater reliability. Tap test is sensitive and easy to manipulate, and allows us to reduce radiation exposure. Although its false positive rate is relatively higher than gravity stress test, it still has good application prospects in the intraoperative assessment of the integrity of the deltoid ligament. Key words: Ligaments; Wounds and injuries; Treatment outcome

Candor Laws Growing, but Are They Effective?

Candor Laws Growing, but Are They Effective?

Problems of private practice may deter young doctors, consultants warn

Senior consultants in private practice fear that the sector’s problems may deter younger doctors from entering it and that some will not be sufficiently skilled, a conference has heard. Brian O’Connor, who chairs the specialist committee of the Independent Doctors Federation, warned of the effects of falling profit margins and increasing constraints on doctors’ private work. “We are concerned about younger doctors electing not to go into private practice,” he said. “There’s a fear among us of a slightly older generation that the newer guys are not necessarily being trained up to the calibre that is …

Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression.

Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival. Muscle mass was calculated as total psoas area (TPA)/ vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases surgery, at the mid L3 vertebral level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. 86 patients were followed for 1 year, with an overall mortality of 39.5%. Mortality rates at 1 year were significantly high among patients in the lowest quartile of muscle mass, compared with those in the highest quartile (57.1 vs 23.8%, p=0.02). Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.

Skeletal Muscle Mass is a Prognostic Marker at Diagnosis in Patients with Metastatic Spinal Cord Compression

Introduction Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity, and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision-making, in these individuals, by investigating the association between muscle mass and 1-year survival. Materials and Methods Muscle mass was calculated as total psoas area (TPA)/vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases diagnosis, at the L3 level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. Results A total of 86 patients were followed for 1 year, with overall mortality at 39.5%. There was no gender difference although those alive at 1 year were of a significantly younger age. Alive at 1 year mean age was 62 years (IQR 53–71.75) versus dead at 1 year mean age was 68 years (IQR 61.75–76.25); ( p = 0.04). Significantly more patients in the lowest quartile of muscle mass died within 1 year, compared with the highest quartile (57.1 vs. 23.8%, p = 0.02). Individuals who died within a year had significantly lower lean muscle mass on initial CT compared with those alive at the end of 1 year ( p = 0.05). Patients with lung and gastrointestinal primary malignancies were more likely to die at 1 year, with both groups having 1-year survival rates less than 50%. Of the malignancies recorded, lung primary patients had a significantly lower muscle mass on CT than breast and lymphoma patients ( p &lt; 0.01). Conclusion Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may influence decision to operate patients with spinal metastases.