Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: Interbody techniques for lumbar fusion

pre-printInterbody fusion techniques have been promoted as an adjunct to lumbar fusion procedures in an effort to enhance fusion rates and potentially improve clinical outcome. The medical evidence continues to suggest that interbody techniques are associated with higher fusion rates compared with posterolateral lumbar fusion (PLF) in patients with degenerative spondylolisthesis who demonstrate preoperative instability. There is no conclusive evidence demonstrating improved clinical or radiographic outcomes based on the different interbody fusion techniques. The addition of a PLF when posterior or anterior interbody lumbar fusion is performed remains an option, although due to increased cost and complications, it is not recommended. No substantial clinical benefit has been demonstrated when a PLF is included with an interbody fusion. For lumbar degenerative disc disease without instability, there is moderate evidence that the standalone anterior lumbar interbody fusion (ALIF) has better clinical outcomes than the ALIF plus instrumented, open PLF. With regard to type of interbody spacer used, frozen allograft is associated with lower pseudarthrosis rates compared with freeze-dried allograft; however, this was not associated with a difference in clinical outcome

INSPIROWANE KOJOTAMI PODEJŚCIE DO PRZEWIDYWANIA TOCZNIA RUMIENIOWATEGO UKŁADOWEGO Z WYKORZYSTANIEM SIECI NEURONOWYCH

Systemic Lupus Erythematosus (SLE) is a complicated autoimmune disease that can present with a variety of clinical symptoms, making precise prognosis difficult. Because SLE has a wide range of symptoms and may overlap with other autoimmune and inflammatory disorders, making a diagnosis can be challenging. This study creates a precise and accurate model for the prediction of SLE using the GEO dataset. For cost-effective data collection and analysis, feature selection might be essential in some applications, particularly in healthcare and scientific research. The strength of Artificial Neural Networks (ANN) for Systemic Lupus Erythematosus prediction and the Coyote Optimization Algorithm (COA) for feature selection are combined in this study. The COA is an optimization method influenced by nature and coyote hunting behavior. This study attempts to improve the effectiveness of subsequent predictive modeling by using COA to identify a subset of significant features from high-dimensional datasets linked to SLE. A Multi-layer Feed-forward Neural Network, a potent machine learning architecture renowned for its capacity to discover complex patterns and correlations within data, is then given the chosen features. Because the neural network is built to capture SLE's intricate and non-linear structure, it offers a reliable foundation for precise classification and prediction. The accuracy of the COA-ANN model was 99.6%.Toczeń rumieniowaty układowy (SLE) jest skomplikowaną chorobą autoimmunologiczną, która może objawiać się różnymi objawami klinicznymi, co utrudnia dokładne rokowanie. Ponieważ SLE ma szeroki zakres objawów i może nakładać się na inne choroby autoimmunologiczne i zapalne, postawienie diagnozy może być trudne. Niniejsze badanie tworzy precyzyjny i dokładny model przewidywania SLE z wykorzystaniem zbioru danych GEO. W celu efektywnego kosztowo gromadzenia i analizy danych, wybór cech może być niezbędny w niektórych zastosowaniach, szczególnie w opiece zdrowotnej i badaniach naukowych. W niniejszym badaniu połączono siłę sztucznych sieci neuronowych (ANN) do przewidywania tocznia rumieniowatego układowego i algorytmu optymalizacji Coyote (COA) do wyboru cech. COA to metoda optymalizacji, na którą wpływ ma natura i zachowania łowieckie kojotów. Niniejsze badanie ma na celu poprawę skuteczności późniejszego modelowania predykcyjnego poprzez wykorzystanie COA do identyfikacji podzbioru istotnych cech z wielowymiarowych zbiorów danych powiązanych z SLE. Wielowarstwowa sieć neuronowa Feed-forward, potężna architektura uczenia maszynowego znana ze swojej zdolności do odkrywania złożonych wzorców i korelacji w danych, otrzymuje następnie wybrane cechy. Ponieważ sieć neuronowa została zbudowana w celu uchwycenia skomplikowanej i nieliniowej struktury SLE, oferuje ona niezawodną podstawę do precyzyjnej klasyfikacji i przewidywania. Dokładność modelu COA-ANN wyniosła 99,6%

Spinal column shortening versus revision detethering for recurrent adult tethered cord syndrome: a preliminary comparison of perioperative and clinical outcomes.

OBJECTIVE:Recurrent tethered cord syndrome (TCS), believed to result from tension on the distal portion of the spinal cord, causes a constellation of neurological symptoms. Detethering surgery has been the traditional treatment for TCS. However, in cases of recurrent TCS, there is a risk of new neurological deficits developing, and subsequent retethering is difficult to prevent. Spinal column shortening has been proposed as an alternative technique to reduce the tension on the spinal cord without incurring the morbidity of revision surgery on the spinal cord. The authors compared the perioperative outcomes and morbidity of patients who were treated with one or the other procedure. METHODS:The medical records of 16 adult patients with recurrent TCS who were treated between 2005 and 2018 were reviewed. Eight patients underwent spinal column shortening, and 8 patients underwent revision detethering surgery. Patient demographics, clinical outcomes, and perioperative factors were analyzed. The authors include a video to illustrate their technique of spinal column shortening. RESULTS:Within the spinal column shortening group, no patients experienced any complications, and all 8 patients either improved or stabilized with regard to lower-extremity and bowel and bladder function. Within the revision detethering group, 2 patients had worsening of lower-extremity strength, 3 patients had worsening of bowel and bladder function, and 1 patient had improvement in bladder function. Also, 3 patients had wound-related complications. The median estimated blood loss was 731 ml in the shortening group and 163 ml in the revision detethering group. The median operative time was 358 minutes in the shortening group and 226 minutes in the revision detethering group. CONCLUSIONS:Clinical outcomes were comparable between the groups, but none of the spinal column shortening patients experienced worsening, whereas 3 of the revision detethering patients did and also had wound-related complications. Although the operative times and blood loss were higher in the spinal column shortening group, this procedure may be an alternative to revision detethering in extremely scarred or complex wound revision cases

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery.

ObjectiveThis retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery.MethodsAdults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery.ResultsA total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03).ConclusionPreoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery

A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report

This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits

Healthcare of the Uninsured Population in West Virginia and the United States

Introduction: The uninsured population in the United States has increased dramatically over the past few years. Hospitals and physicians bear the financial burden of the uninsured by compensating for the billions of dollars in bad debt or uncompensated care they incur each year. Emergency rooms and other healthcare facilities are left with billions in uncompensated care due to 47 million uninsured Americans. Uncompensated care in 2006 was $31.2 billion. Majority of individuals accounting for uncompensated care are those living at or below the federal poverty level and those individuals who can afford health coverage but freely choose to forgo purchasing health insurance. Under the Affordable Care Act of 2010 the number of uninsured Americans will be decrease by 32 million, helping reduce the annual cost of uncompensated care. The purpose of this research was to analyze the effects of the uninsured population on the insured population in terms of quality of, cost, and access to health care. Methodology: The methodology for this study was a literature review. Four electronic data bases were used with a total of 31 articles referenced for this research. Results: Uncompensated care was shown to increase health insurance premiums of the insured population by$1,000 annually. Cost-shifting represents around 1.7% of private health insurance costs. An estimated $14 billion could be funded through cost shifting. Under the Affordable Care Act, the uninsured population is estimated to decrease substantially, thus reducing annual uncompensated care costs. Discussion/Conclusion: Effects of the uninsured population on the insured exhibited mixed results. When discussing effects on the insured due to the billions in uncompensated care, health insurance premiums were shown to increase and rises in cost shifting were noted. Reducing the population of uninsured Americans has a direct correlation with reducing uncompensated care costs

Use of Smartphones in Hospitals

Mobile technology has begun to change the landscape of the medical profession with more than two-thirds of physicians regularly using smart phones. Smartphones have allowed healthcare professionals and the general public to communicate more efficiently, collect data and facilitate the clinical decision making. The methodology for this study was a qualitative literature review following a systematic approach of the smartphone usage among physicians in hospitals. Fifty-one articles were selected for this study based on inclusion criteria. The findings were classified and described into seven categories: use of smartphone in obstetrics, pediatrics, surgery, internal medicine, radiology, and dermatology which were chosen based on the documented use of smartphone application in different healthcare practices. A last section of patient safety and issues with confidentiality is also described. This study suggest that smartphones have been playing an increasingly important role in healthcare. Medical professionals have become more dependent upon medical smartphone applications. However, concerns of patient safety and confidentiality will likely lead to increased oversight of mobile device use by regulatory agencies and accrediting bodies

Radiographic Outcomes of Adult Spinal Deformity Correction : A Critical Analysis of Variability and Failures Across Deformity Patterns

Study Design: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. Summary of Background Data: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. Methods: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30 , GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10 , and PT greater than 20 . According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. Fondation Paristech, ISS

Radiological data of brachial plexus avulsion injury associated spinal cord herniation (BPAI-SCH) and comparison to anterior thoracic spinal cord herniation (ATSCH).

Spinal cord herniation (SCH) is a rare cause of myelopathy. When reported, SCH has most commonly been described as occurring spontaneously in the thoracic spine, and being idiopathic in nature (anterior thoracic spinal cord herniation, ATSCH) [1-3]. Several theories have been proposed to explain its occurrence, including congenital, inflammatory, and traumatic etiologies alike [1-4]. Even more rarely, SCH has been described to occur in the cervical spine in association with brachial plexus avulsion injuries (BPAI-SCH). In our accompanying article, Late Cervical Spinal Cord Herniation Resulting from Post-Traumatic Brachial Plexus Avulsion Injury, two cases of BPAI-SCH are presented and discussed in the context of the reviewed literature [5]. Here, pertinent accompanying follow-up data was collected and is presented for the cases, including postoperative radiographic outcome imaging. Furthermore, a table is presented comparing and contrasting ATSCH to BPAI-SCH. Although the two phenomena have been previously grouped together, this table highlights ATSCH and BPAI-SCH as distinct entities; more specifically, BPAI-SCH is a separate, long-term complicating feature of BPAI. This supplementary data helps treating physicians by increasing awareness and knowledge of BPAI-SCH as a distinct entity from ATSCH and cause of delayed neurological deterioration