Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry

Introduction: Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry. Materials and methods: Between May 2005 and February 2010 the database query resulted in 1,764 patients. The patients were subdivided into three socio-economically relevant age groups:<65years, 65-74years,≥75years. Frequencies for occurred surgical, general and follow-up complications were assessed. Multivariate and univariate logistic regressions were performed to reveal predictors for respective complication types. Results and discussion: Our study found that age, ASA status and blood loss were significant co-varieties for the occurrence of general complications. The risk of general complications is increased in older versus younger patients. Fusion or rigid stabilization does not lead to more complications. Surgical complications as well as complication rates at follow-up showed no significant age-related variation. Physician-based outcome was good or excellent in over 80% of patients in all age group

Outcomes in endoscopic sinus surgery: olfaction, nose scale and quality of life in a prospective cohort study

OBJECTIVES: To determine the efficacy of endoscopic sinus surgery (ESS) on olfactory function in chronic rhinosinusitis patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and to compare the nasal obstruction and symptom evaluation (NOSE) scale before and after surgery. DESIGN: A prospective cohort study. SETTING: Royal National Throat and Nose and Ear Hospital, London UK. PARTICIPANTS: One hundred and thirteen patients with CRS; 60 CRSwNP and 53 CRSsNP. OUTCOME ASSESSMENTS: Olfaction was measured using both the University of Pennsylvania Smell Investigation Test (UPSIT) and the ‘sense of smell’ visual analogue scale (VAS). The NOSE scale, the sinonasal outcome test (SNOT 22) and the Lund–Kennedy (LK) surgeon reported scores were also measured pre- and postoperatively at 6 months. RESULTS: The UPSIT psychophysical measurement significantly improved following ESS in the CRSwNP subgroup as did the patients perceived VAS sense of smell. However, in the CRSsNP subgroup, the improved VAS and UPSIT measurements were not significant. The NOSE, SNOT 22 and LK scores all improved significantly. The olfactory improvement as measured by the UPSIT correlated to the SNOT-22, but a correlation between the NOSE score and UPSIT was not found. CONCLUSIONS: Endoscopic sinus surgery significantly improved the patient's perceived and measured sense of smell in the CRSwNP subgroup which is the most surgically responsive CRS subgroup. Additionally, improved olfaction in the CRSwNP subgroup is most likely to improve the patient's quality of life. Endoscopic sinus surgery significantly improved the NOSE scale in both CRS subgroups at 6 months following surgery

The high flex total knee arthroplasty : higher incidence of aseptic loosening and no benefit in comparison to conventional total knee arthroplasty : minimum 16‑years follow‑up results

Purpose: This prospective randomized study compares the clinical and radiographic long-term results at least 16 years after total knee arthroplasty (TKA) between a mobile-bearing high flex and a fixed-bearing posterior-stabilized knee. Methods: In 2000, we included 60 patients who underwent a TKA. Patients were divided into two groups. At the time of the follow-up after a minimum of 16 years (16.5 years ± 0.6), 16 patients had died for causes unrelated to the operation, 15 were lost to the follow-up. Five patients of the high flex group had a revision. The final evaluation included the hospital for special surgery score (HSS) and radiographs. Using the X-rays and the Knee Society Roentgenographic Evaluation and Scoring System, radiolucent lines and the maximal knee flexion were determined. Results: No significant differences between the two groups were found. The mean HSS score of LPS group patients was 87.9 (± 10.6) points and that of the high flex group was 93.1 (± 7.4) points. Five patients of the high flex group had undergone a reoperation. One knee was revised for painful mid-flexion instability and the others for symptomatic aseptic loosening of the components. Conclusion: The long-term follow-up does not show any clear benefits and even a higher incidence of implant loosening using the mobile-bearing high-flex knee.Publikationsfonds ML

Correction to : the high flex total knee arthroplasty : higher incidence of aseptic loosening and no benefit in comparison to conventional total knee arthroplasty : minimum 16‑years follow‑up results

Publikationsfonds ML

Behavioral and hormonal assessment of stress in foals (Equus caballus) throughout the weaning process

This study had the aim to demonstrate the midterm effects (three weeks) of weaning on foals’ welfare. For this purpose, foals’ behavioral changes and fecal levels metabolites of cortisol were evaluated. The observations took place at the state stud farm of Baden-Wuerttemberg in Germany. Ten foals (six colts and four fillies) were observed from one day before weaning up until three weeks after weaning. Weaning was divided into three blocks, the first in September, the second in October, and the last in November. The behavioral observation was done during an eight-hour period between 7:00 a.m. and 5:00 p.m. The observer documented the exact behavior shown by the foal every five minutes during the eight hours. To scale the stress experienced by the foal, the glucocorticoid metabolite 11,17-dioxoandrostane was measured with the 11-oxoetiocholanolone enzyme immunoassay, which allows assessing the foal’s plasma cortisol level changes throughout the trail through fecal samples. All foals displayed a distinct hormonal stress response to the weaning process through increased fecal cortisol metabolite levels. Their body posture distribution took a shift from mainly moving before weaning to mainly standing during the three weeks after weaning. Compared with the day before weaning, the foals showed less active behavior and significantly increased their resting behavior. Regarding the overall resting behavior, the weaned foals initially increased their time spent resting in a lying position during daytime and then started to decrease the time lying. After weaning, the foals showed a significant increase in resting while standing. In conclusion, the foals showed an expected behavioral development and an expected curve of cortisol metabolite values throughout the study. However, it seemed that the changes had not returned “back to normal” at three weeks after weaning. Therefore, we suggest that weaned foals need a minimum of three weeks to acclimate to the new situation

Effects of sensorimotor training on transversus abdominis activation in chronic low back pain patients

(1) Background: The aim of this study was to investigate and compare the effect of sensorimotor training on transversus abdominis activation. (2) Methods: Seventy-five patients with chronic low back pain were randomly assigned to one of three groups (whole body vibration training using Galileo®, coordination training using Posturomed®, or physiotherapy (control)). Transversus abdominis activation was measured by using sonography pre- and post-intervention. Second, changes in clinical function tests and their correlation with the sonographic measurements were determined. (3) Results: All three groups showed an improvement in activation of the transversus abdominis post-intervention, with the Galileo® demonstrating the largest improvement. There were no relevant (r > 0.5) correlations between activation of the transversus abdominis muscle and any clinical tests. (4) Conclusions: The present study provides evidence that sensorimotor training on the Galileo® significantly improves the activation of the transversus abdominis muscle

Individual Pharmacotherapy Management (IPM) - I : a group-matched retrospective controlled clinical study on prevention of complicating delirium in the elderly trauma patients and identification of associated factors

Background: Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods: In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results: There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions: IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.Publikationsfonds ML

Reference data by player position for an ice hockey-specific complex test

The aim of this study was to investigate position-specific (forwards, defenders) reference data for a scientifically evaluated (validity, reliability) ice hockey-specific complex test (IHCT). One hundred and four 3rd league professional ice hockey field players (mean ± standard deviations (SD); age: 26.4 ± 5.62 years) volunteered for the investigation. Players were categorized as forwards (n = 64) and defenders (n = 40). Data from the IHCT were collected over six seasons from three 3rd league teams. The IHCT included parameters for load (e.g., 10 m and 30 m skate times, transition and weave agility times with and without a puck, slap and wrist shots on goal) and stress (e.g., lactate, heart rate). The only significant (p < 0.002) difference between forwards and defenders for performance were found for weave agility with puck (p < 0.001). Forwards showed a higher average performance in this parameter than defenders. Differences were also found in weave agility without a puck (p = 0.008), 30 m backward sprinting without puck (p = 0.012) and goals after test (p = 0.030). This study provides position-specific reference data for a valid and reliable ice hockey-specific complex test for the 3rd league. These results may be used by coaches to judge player performance based on position (forwards vs. defenders). Moreover, coaches may use these data to evaluate the effectiveness of the most recent training period. Further research should extend this database to 1st and 2nd league players in order to enhance the scope of the test

Population pharmacokinetics of cefuroxime and uptake into hip and spine bone of patients undergoing orthopaedic surgery

Objectives: To reduce the incidence of peri- or postoperative infections in orthopaedic surgery, patients are prophylactically treated with antibiotics. Here, we wanted to know whether effective bone and intervertebral disc concentrations of cefuroxime are reached. Methods: Patients undergoing surgery of hip (N = 40; 62.5% male) or spine (N = 40; 55% male) were pretreated with 1.5 g of the second-generation cephalosporin cefuroxime before surgery. We studied plasma population kinetics and bone and intervertebral disc (C5/6 till L5/S1) concentrations of cefuroxime using high-performance liquid chromatography. Key findings: The plasma kinetics of cefuroxime in 80 patients was analysed using a population approach. The clearance amounted to 7.86 l/h. The peripheral and central volumes of distribution were estimated as 8.45 and 10.4 l, respectively. The concentrations in hip samples amounted to 9.8 ± 0.6 µg/g in cancellous bone and 8.9 ± 0.8 µg/g in cortical bone. Cefuroxime concentrations in vertebral bone and intervertebral discs were calculated as 9.6 ± 1.3 and 8.9 ± 1.1 µg/g, respectively. Conclusion: Even if a majority of patients undergoing hip or spine surgery probably achieved adequate concentrations of cefuroxime, not all patients reached bone concentrations of cefuroxime above a recommended breakpoint for susceptible germs at the time of surgery.Publikationsfond ML

Minimally invasive cartilage resection of the subtalar joint : an anatomical study

Background: Subtalar arthrodesis is a commonly performed procedure for the treatment of posttraumatic or primary osteoarthritis and several hindfoot deformities. The primary objective of this study is to evaluate the efficacy and safety of a minimally invasive technique for cartilage removal of the subtalar joint using a modified sinus tarsi approach. Methods: An anatomical study was performed on 8 pairs of fresh frozen cadaveric feet. A modified 2.5-cm sinus tarsi approach was used to access the subtalar joint. Cartilage removal was performed in 2 groups using either a 13-mm Shannon burr (GB) or a curette (GC) with subsequent systematic dissection. Standardized scaled photographs of the resected articular surfaces were analyzed in ImageJ software to quantify cartilage removal. Nearby vulnerable anatomical structures such as the intermediate and lateral dorsal cutaneous nerves, peroneal, tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons were assessed for injury. Results: The area of completely removed cartilage in GC was median 79.7% talar and 76.6% calcaneal. In GB, median 67.8% of the talar cartilage and 76.8% of the calcaneal cartilage was removed. The overall mean of cartilage resection was 73% (±7.7). There was no statistically significant difference between the groups. Anatomical structures at risk were not inadvertently injured. Conclusion: Subtalar cartilage resection can be performed safely using a minimally invasive modified sinus tarsi approach and either a Shannon burr or curettes. The amount of cartilage resection is less than that reported in the literature for open cartilage resection, but may be beneficial in select patient populations at increased risk for wound healing compromise and infection. Level of Evidence: Level III, comparative cadaver stud