Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

[Study Design] Multicenter, prospective study. [Purpose] To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. [Overview of Literature] To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. [Methods] The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. [Results] JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. [Conclusions] Poor glycemic control might prevent postoperative functional recovery of the spinal cord

Application of Micro Slurry-Jet Erosion (MSE) for the Evaluation of Surface Properties of PVD TiN / TiCN Two-Layer Coatings

In this study, the potential of a Micro Slurry-jet Erosion (MSE) test to swiftly evaluate the intrinsic surface strength properties of thin multi-layer coatings is demonstrated. A slurry containing 1.2 &mu;m alumina particles was impacted at high velocity perpendicular to PVD TiN/TiCN (TiCN on top of TiN) and TiN coatings deposited on high-speed steel by a hollow cathode discharge (HCD) or an cathodic arc (CA) method. In addition, nano-indentation and XRD, GDOES analyses were done for the original surfaces. By measuring the variation of erosion depth against test time, the MSE test made it possible to evaluate the individual erosion properties of TiCN and TiN layers independent of the substrate. Although the hardness of TiCN layers, coated by HCD or CA, was measured with nano-indentation and found to be approximately 20% higher than for TiN, the erosion rates of TiCN layers were found to be between 32% and 38% of the erosion rate of TiN. For the HCD coating, the erosion proceeded uniformly and produced a mostly smooth surface. On the other hand, for the CA coating, a pitted surface was observed. The existence of the hollows blemishes which caused by macroparticles i. e. droplets in the coating may affect the difference in the erosion rates between HCD and CA coatings. Consequently, the MSE test may be useful to evaluate the difference of the morphology of coatings as well as the surface strength which are related with the fabrication process

Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years

We retrospectively reviewed the medical charts of 210 consecutive patients treated for spinal infection in Tottori University Hospital in Japan between 1956 and 2005. Until 1995, spinal infection was under control in this series; however, during the last decade, it has been on the rise. Male predominance had been gradually progressing, and 69% of the patients were male during the last decade. Patients with spinal infection were aging, and the ratio of immunocompromised hosts dramatically increased to 53%. Until 1995, the percentage of patients with tuberculous spondylitis had been declining; however, the incidence has been on the rise during the last ten years. The organism was detected in 64% of patients treated between 1996 and 2005, of which Staphylococcus aureus was detected in 49%. Moreover, methicillin-resistant S. aureus was detected in 61% of patients with S. aureus. There were no immigrants or cases with human immunodeficiency virus in this series

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study

With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required