Comparing The Efficacy Of Tranexamic Acid And Aminocaproic Acid In Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis

COMPARING THE EFFICACY OF TRANEXAMIC ACID AND AMINOCAPROIC ACID IN POSTERIOR SPINAL FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS. Yunsoo A. Lee and Brian G. Smith. Department of Orthopedics, Yale University, School of Medicine, New Haven, CT. Objective: To compare the efficacy of tranexamic acid and aminocaproic acid in decreasing blood loss and blood transfusion requirements during posterior spinal fusion for the treatment of adolescent idiopathic scoliosis. Background: Due to the extent of the operation, posterior spinal fusion is associated with significant blood loss often requiring blood transfusions that increase the risk of morbidity and mortality. Antifibrinolytic medications, mainly tranexamic acid (TXA) and aminocaproic acid (Amicar), have been shown to reduce blood loss and blood transfusion requirements in studies on surgery for scoliosis. Our study compares the efficacy of using TXA and Amicar to using no anti-fibrinolytic in reducing blood loss and blood transfusion requirements. Methods: A retrospective chart review was performed on all patients with idiopathic scoliosis undergoing exclusive posterior spinal fusion from 2008 to 2016 at one institution. Patients were put into three groups, a historical control group that was not given anti-fibrinolytics (67), a group given TXA (46), and a group given Amicar (21). There were no significant differences in age, gender, number of fused vertebrae, or Major Cobb angle between the three groups. Results: The TXA group required significantly fewer average units of packed red blood cell (PRBC) transfusion (1.76 ± 1.25) than the control group (2.57 ± 1.41). The Amicar group (2.24 ± 1.04) did not demonstrate a significantly reduced blood transfusion requirement. There were no significant differences seen in intraoperative estimated blood loss across the three groups. Multiple regression analysis showed that TXA was significantly associated with a reduction in PRBC transfusion and that the number of vertebrae levels fused was significantly associated with an increase in blood transfusion. In contrast, Amicar did not demonstrate a statistically significant reduction in blood transfusion requirements. Conclusion: We analyzed 134 patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis to compare the effects of tranexamic acid (TXA) and aminocaproic acid (Amicar) to a control group given no anti-fibrinolytic therapy. TXA was found to significantly decrease packed red blood cell transfusion requirements while Amicar did not show a statistically significant change. Neither were associated with a decrease in intraoperative estimated blood loss

The Great Recession, Government Performance, and Citizen Trust

his paper contains a portion of the authors dissertation presented for the degree of Doctor of Philosophy at Rutgers University.Performance theory holds that a high level of government performance leads to citizen trust. Nonetheless, the nature of the relationship between performance and trust continues to elude researchers because of the possibility of reverse causality. To strengthen the validity of causal inference, a researcher needs to look for naturally occurring changes in performance and in turn trust in government. The Great Recession that began around 2008 provides an opportunity to better demonstrate a causal relationship between government performance and citizen trust because it represents an exogenous shock to both the macro and micro performance of government, particularly in several southern European countries most profoundly affected by the crisis. Against this backdrop, the purpose of this article is to probe the causal relationship between government performance and citizen trust in Europe in the context of the Great Recession. This article compares before-after trends in citizen trust in government in Greece, Italy, Portugal, and Spain, with that of Belgium, France, Germany, and the Netherlands using the European Social Survey. The difference-in-differences regression results show that the Great Recession had a dire influence on citizen trust in government, corroborating performance theory

The NPM Legacy: The Impacts of Job Insecurity, Innovativeness, and Public Employees Trust in Their Supervisors on Organizational Performance

New Public Management posed challenges to governments by emphasizing the flexibility of workforce, innovation, and the role of supervisors in running public sector organizations. However, there is debate over whether job insecurity and organizational innovativeness contribute to organizational performance in the public sector. Furthermore, despite the growing awareness of the importance of supervisors, the issue of public sector employees trust in their supervisors has received relatively little attention. The purpose of this article is to examine the impacts of job insecurity, innovation, and employees trust in supervisors on organizational performance in order to explain these inconsistencies and fill the void in past research. It develops a structural equation model, built on two sets of Korean public employee survey data, whose results show that job insecurity is negatively related to performance, while employees trust in supervisors and organizational innovativeness are positively associated with performance. In addition, employees trust in supervisor is positively related to innovativeness

Governments in need are governments indeed: The impacts of job insecurity on trust in government

In spite of voluminous literature on citizen trust in government and job insecurity, the relationship between job insecurity and trust in government has been overlooked. Drawing on performance theory and psychological democratic contract model, this study assesses the effects of job insecurity on trust in government. Using the Latinobarometer 2017, the findings suggest that job insecurity has a substantial negative impact on trust in government. A closer look at the impacts of job insecurity on various parts of government reveals a slightly differentiated picture. While job insecurity reduces trust in a national government, Congress, and the Court, it does not have a damaging impact on trust in police

The Effect of Shared Leadership on Team Processes and Performance

Purpose - This study examined the effect of shared leadership on student project team processes and outcomes. We focused on shared leadership and its association with team processes (coordination, goal commitment, and knowledge sharing) and team performance. Design/methodology/approach - To examine the shared leadership, team processes, and performance model, we conducted two separate surveys of 158 graduate and undergraduate students working in project teams at a large southwestern university. Findings - Results showed that shared leadership positively affected coordination activities, goal commitment, and knowledge sharing, which in turn, positively affect team performance, even though shared leadership had no direct effect on team performance. Research limitations/implications - Our research adds to the knowledge of important team process factors through which shared leadership indirectly affects team performance. Practical implications - Based on our findings, we provided implications for students and instructors that shared leadership can facilitate team performance by enabling team members to coordinate activities, commit to goals, and share knowledge effectively. Originality/value - This study presents an initial understanding of the shared leadership-team performance relationship by introducing influential variables, such as coordination activities, goal commitment, and knowledge sharing in a team

Case Report and Review of Literature: Autosomal Recessive Hypophosphatemic Rickets Type 2 Caused by a Pathogenic Variant in ENPP1 Gene

Autosomal recessive hypophosphatemic rickets type 2 (ARHR2) is a rare form of hereditary rickets, which is characterized by defective bone mineralization and renal phosphate wasting due to a loss-of-function variant in the ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene. Although pathogenic variant of ENPP1 has been known to manifest other phenotypes including arterial calcification, hearing loss, ossification of posterior longitudinal ligament, or pseudoxanthoma elasticum, there have been few reports including systematic examination in individuals diagnosed with ARHR2 to date. Herein, we report a case of ARHR2 with a bi-allelic pathogenic variant of ENPP1, in which the patient presented with gait abnormalities with severe genu varum at 26 months of age. Targeted gene panel sequencing was performed to investigate the genetic cause of rickets, and a homozygous nonsense variant in ENPP1, c.783C>G (p.Tyr261*), was identified. The patient was treated with oral phosphate and active vitamin D supplements and underwent corrective osteotomy for varus deformity. His phenotype was limited to rickets. A periodic systematic evaluation is needed to identify any comorbidities in ARHR2 patients since ENPP1 variants may present phenotypes other than rickets and symptoms may evolve or change over time

Comparison and optimization of sheep in vivo intervertebral disc injury model.

Background The current standard of care for intervertebral disc (IVD) herniation, surgical discectomy, does not repair annulus fibrosus (AF) defects, which is partly due to the lack of effective methods to do so and is why new repair strategies are widely investigated and tested preclinically. There is a need to develop a standardized IVD injury model in large animals to enable comparison and interpretation across preclinical study results. The purpose of this study was to compare in vivo IVD injury models in sheep to determine which annulus fibrosus (AF) defect type combined with partial nucleus pulposus (NP) removal would better mimic degenerative human spinal pathologies. Methods Six skeletally mature sheep were randomly assigned to one of the two observation periods (1 and 3 months) and underwent creation of 3 different AF defect types (slit, cruciate, and box-cut AF defects) in conjunction with 0.1 g NP removal in three lumbar levels using a lateral retroperitoneal surgical approach. The spine was monitored by clinical CT scans pre- and postoperatively, at 2 weeks and euthanasia, and by magnetic resonance imaging (MRI) and histology after euthanasia to determine the severity of degeneration (disc height loss, Pfirrmann grading, semiquantitative histopathology grading). Results All AF defects led to significant degenerative changes detectable on CT and MR images, produced bulging of disc tissue without disc herniation and led to degenerative and inflammatory histopathological changes. However, AF defects were not equal in terms of disc height loss at 3 months postoperatively; the cruciate and box-cut AF defects showed significantly decreased disc height compared to their preoperative height, with the box-cut defect creating the greatest disc height loss, while the slit AF defect showed restoration of normal preoperative disc height. Conclusions The tested IVD injury models do not all generate comparable disc degeneration but can be considered suitable IVD injury models to investigate new treatments. Results of the current study clearly indicate that slit AF defect should be avoided if disc height is used as one of the main outcomes; additional confirmatory studies may be warranted to generalize this finding

Correction of Spinal Sagittal Alignment after Posterior Lumbar Decompression: Does Severity of Central Canal Stenosis Matter?

Study Design This study adopted a retrospective study design. Purpose Our study aimed to investigate the impact of central canal stenosis severity on surgical outcomes and lumbar sagittal correction after lumbar decompression. Overview of Literature Studies have evaluated sagittal correction in patients with central canal stenosis after lumbar decompression and the association of stenosis severity with worse preoperative sagittal alignment. However, none have evaluated the impact of spinal stenosis severity on sagittal correction. Methods Patients undergoing posterior lumbar decompression (PLD) of ≤4 levels were divided into severe and non-severe central canal stenosis groups based on the Lee magnetic resonance imaging (MRI) grading system. Patients without preoperative MRI or inadequate visualization on radiographs were excluded. Surgical characteristics, clinical outcomes, and sagittal measurements were compared. Multivariate logistic regression was performed to determine the predictors of pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI–LL). Results Of the 142 patients included, 39 had severe stenosis, and 103 had non-severe stenosis. The mean follow-up duration for the cohort was 4.72 months. Patients with severe stenosis were older, had higher comorbidity indices and levels decompressed, and longer lengths of stay and operative times (p0.05). On multivariate regression, severe stenosis was a significant predictor of a lower preoperative LL (estimate=−5.243, p=0.045) and a higher preoperative PI–LL mismatch (estimate=6.192, p=0.039). No differences in surgical or clinical outcomes were observed (p>0.05). Conclusion Severe central lumbar stenosis was associated with greater spinopelvic mismatch preoperatively. Sagittal balance improved in both patients with severe and non-severe stenosis after PLD to a similar degree, with differences in sagittal parameters remaining after surgery. We also found no differences in postoperative outcomes associated with stenosis severity

Lateral Approach to the Lumbar Spine: The Utility of an Access Surgeon

BACKGROUND: Lateral lumbar interbody fusions (LLIFs) utilize a retroperitoneal approach that avoids the intraperitoneal organs and manipulation of the anterior vasculature encountered in anterior approaches to the lumbar spine. The approach was championed by spinal surgeons; however, general/vasculature surgeons may be more comfortable with the approach. OBJECTIVE: The objective of this study was to compare short-term outcomes following LLIF procedures based on whether a spine surgeon or access surgeon performed the approach. MATERIALS AND METHODS: We retrospectively identified all one- to two-level LLIFs at a tertiary care center from 2011 to 2021 for degenerative spine disease. Patients were divided into groups based on whether a spine surgeon or general surgeon performed the surgical approach. The electronic medical record was reviewed for hospital readmissions and complication rates. RESULTS: We identified 239 patients; of which 177 had approaches performed by spine surgeons and 62 by general surgeons. The spine surgeon group had fewer levels with posterior instrumentation (1.40 vs. 2.00; CONCLUSION: Similar outcomes may be seen regardless of whether a spine or access surgeon performs the approach for an LLIF

Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis

STUDY DESIGN: Retrospective cohort study. PURPOSE: Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. OVERVIEW OF LITERATURE: The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography. METHODS: We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of \u3e10° or \u3e8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. RESULTS: A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p =0.041; and 28.1% vs. 14.6%, p =0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p \u3e0.20). CONCLUSIONS: Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph