-
World Neurosurgery Jul 2023Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. This study systematically analyzes...
OBJECTIVE
Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. This study systematically analyzes LIF nomenclature in contemporary literature and proposes a standardized classification system for reporting LIF terminology.
METHODS
A search query was conducted through the PubMed database using "lumbar fusion OR lumbar interbody fusion." A total of 1455 articles were identified, and 605 references to LIF were recorded. Following a systematic review of the terminology, we developed a LIF reporting guidelines that capture the existing LIF nomenclature while avoiding redundant or ambiguous terminology.
RESULTS
The most referenced anatomical approaches were transforaminal (43.0%), followed by posterior (25.0%), lateral (19.7%), and anterior (10.9%). Overall, there were 72 unique ways to describe LIF. Unique prefixes were recorded by approach (posterior: 26; lateral: 13; anterior: 3). Forty unique prefixes/suffixes overlapped in their usage. "MI" (14.4%), "MIS" (38.1%), and "MISS" (0.6%) all referenced a minimally invasive approach. "O" (12.5%), "CO" (1.3%), and "TO" (1.3%) all described open techniques. "Endo" (0.6%), "Endoscopic-assisted" (1.3%), and "PE" (1.9%) all referenced endoscopic-assisted procedures.
CONCLUSIONS
The current LIF nomenclature contains many unique LIF terms that were found to be inconsistently defined, redundant, or ambiguous. We propose the standardization of a 4-part naming system which highlights the crucial parts of LIF: (1) intraoperative repositioning, (2) patient position, (3) anatomical approach, and (4) orientation of the surgical corridor to the psoas muscles.
Topics: Humans; Minimally Invasive Surgical Procedures; Lumbosacral Region; Spinal Fusion; Lumbar Vertebrae
PubMed: 36921714
DOI: 10.1016/j.wneu.2023.03.040 -
Frontiers in Oncology 2021The effect of sarcopenia on the clinical outcomes of patients with malignant neoplasms receiving immune checkpoint inhibitors (ICIs) is unclear. The aim of this study...
BACKGROUND
The effect of sarcopenia on the clinical outcomes of patients with malignant neoplasms receiving immune checkpoint inhibitors (ICIs) is unclear. The aim of this study was to evaluate the effect and survival of patients with malignancies and sarcopenia receiving ICIs.
METHODS
We systematically searched related studies in PubMed, Embase, and Cochrane Library up to March 2021 according to the inclusion and exclusion criteria. Information pertaining to the hazard ratio (HR) corresponding to 95% confidence interval (CI) of overall survival (OS) and progression-free survival (PFS) as determined by univariate and multivariate analyses; the odds ratio (OR) corresponding to the 95% CI of the disease control rate (DCR) and objective response rate (ORR); and immune-related adverse events (irAEs) was collected and analyzed using the RevMan 5.4 software. Study heterogeneity and sensitivity were also assessed.
RESULTS
A total of 19 studies were finalized that included 1763patients with lung, gastrointestinal, and head and neck cancers as well as those with melanoma, renal cell carcinoma, urothelial carcinoma, pancreatic cancer, and soft tissue sarcoma. According to univariate and multivariate analyses, patients with sarcopenia at pre-immunotherapy had poorer PFS and OS than those without. HRs and the corresponding 95% CI of PFS were 1.91(1.55-2.34, p <0.00001) and 1.46 (1.20-1.78, p =0.0001), respectively, and HRs and the corresponding 95% CI of OS were 1.78 (1.47-2.14, p <0.00001) and 1.73 (1.36-2.19, p <0.0001), respectively. Patients with sarcopenia showed poor PFS and OS during treatment. In addition, patients with sarcopenia had worse ORR (OR 0.46, 95% CI 0.28-0.74, p = 0.001) and DCR (OR 0.44, 95% CI 0.31-0.64, p<0.0001); however, the incidence of irAEs of any grade and high-grade in patients with sarcopenia did not increase, OR and the corresponding 95% CI were 0.58(0.30-1.12, p = 0.10) and 0.46(0.19-1.09, p = 0.08). Further, we performed subgroup analysis, skeletal muscle mass index (SMI) and psoas muscle mass index (PMI) stratification. In the SMI group, patients with sarcopenia had poor ORR, DCR, PFS, and OS than those without. In the PMI group, sarcopenia had poor ORR,DCR, and was a poor prognostic factor for PFS and OS according to univariate analysis but had no effect on PFS and OS according to multivariate analysis.
CONCLUSIONS
Patients with malignancies and sarcopenia at pre-immunotherapy or follow-up visits had poorer clinical outcomes than those without, and sarcopenia was a poor predictive factor of ICI immunotherapy outcomes.
PubMed: 34513704
DOI: 10.3389/fonc.2021.726257 -
European Journal of Vascular and... Aug 2019Low psoas muscle mass is associated with increased mortality and morbidity after surgery. Recent evidence has linked low psoas muscle mass with survival after abdominal... (Meta-Analysis)
Meta-Analysis
Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time-to-Event Data.
OBJECTIVE/BACKGROUND
Low psoas muscle mass is associated with increased mortality and morbidity after surgery. Recent evidence has linked low psoas muscle mass with survival after abdominal aortic aneurysm (AAA) repair. The aim of this study was to investigate the prognostic role of low skeletal muscle mass in survival of patients with AAA undergoing open or endovascular aneurysm repair (EVAR).
METHODS
A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42018107793). The prognostic factor of interest was degenerative loss of skeletal muscle. A time-to-event data meta-analysis was performed for all cause mortality using the inverse variance method and the results were reported as summary hazard ratio (HR) and 95% confidence interval (CI). Pooled estimates of peri-operative outcome data were calculated using the odds ratio (OR) or risk difference (RD) and 95% CI. Random-effects models of meta-analysis were applied.
RESULTS
Seven observational cohort studies reporting a total of 1,440 patients were eligible for quantitative synthesis. Patients with low skeletal muscle mass had a significantly higher hazard of mortality than those without low skeletal muscle mass (HR 1.66, 95% CI 1.15-2.40; p = .007). Subgroup analysis including only patients who underwent EVAR showed a marginal survival benefit for patients without low skeletal muscle mass (HR 1.86, 95% CI 1.00-3.43; p = .05). Meta-analysis of two studies found no significant difference in peri-operative mortality (RD 0.04, 95% CI -0.13 to 0.21) and morbidity (OR 1.58, 95% CI 0.90-2.76; p = .11) between patients with and without low skeletal muscle mass.
CONCLUSION
There is a significant link between low skeletal muscle mass and mortality in patients undergoing AAA repair. Prospective studies validating the use of body composition for risk prediction after aortic surgery are required before this tool can be used to support decision making and patient selection.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Body Composition; Endovascular Procedures; Frailty; Health Status; Humans; Muscle, Skeletal; Risk Assessment; Risk Factors; Sarcopenia; Treatment Outcome
PubMed: 31204184
DOI: 10.1016/j.ejvs.2019.03.020 -
Seminars in Thrombosis and Hemostasis Feb 2022Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in...
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
Topics: Aged; Animals; COVID-19; Female; Hematoma; Horses; Humans; Male; Middle Aged; Muscles; Retrospective Studies; SARS-CoV-2
PubMed: 34388842
DOI: 10.1055/s-0041-1732370 -
Trauma Surgery & Acute Care Open 2020Compared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia,...
BACKGROUND
Compared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established. Sarcopenia has been opportunistically assessed via radiographic means but there is as of yet no gold standard. The purpose of this review is to summarize the radiological methods used to diagnose sarcopenia in the acute care setting, and suggest ways in which these methods may lead to a consensus definition of sarcopenia and its relationship to patient outcomes.
METHODS
A systematic survey of medical databases was conducted, with 902 unique publications identified. After screening and application of inclusion and exclusion criteria, data regarding study population, outcome, imaging modality, and criteria for assessment of sarcopenia were extracted from 20 studies. Quality was assessed with the Newcastle-Ottawa Scale.
RESULTS
CT was the imaging modality for 18 of the studies, with total psoas muscle cross-sectional area at the level of L3 and L4 being the dominant method for assessing sarcopenia. Adjustment for body morphology most commonly used patient height or L4 vertebral body area. The majority of articles found radiographically assessed sarcopenia to be significantly correlated to outcomes such as mortality, length of hospital stay, morbidity, and in-hospital complications.
CONCLUSIONS
Establishing a consistent definition would strengthen its applicability and generalizability to admission and discharge planning.
LEVEL OF EVIDENCE
Systematic review, level III.
PubMed: 32201738
DOI: 10.1136/tsaco-2019-000414 -
Annals of Nutrition & Metabolism 2019Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial.
AIM
The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy.
METHODS
Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3).
RESULTS
Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14-1.63; p = 0.0008; I2 = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15-1.58; p = 0.0002; I2 = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14-1.73; p = 0.002; I2 = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28-2.09; p < 0.0001; I2 = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied.
CONCLUSIONS
All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.
Topics: Adipose Tissue; Digestive System Neoplasms; Digestive System Surgical Procedures; Humans; Morbidity; Muscle, Skeletal; Postoperative Complications; Risk Factors; Sarcopenia; Tomography, X-Ray Computed
PubMed: 30513518
DOI: 10.1159/000494887 -
BMC Geriatrics Sep 2021The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD.
METHODS
PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated.
RESULTS
Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58-3.27, P < 0.001; I = 60.0%, P = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84-4.46, P < 0.001; I = 0%, P = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89-5.22, P = 0.090; I = 91.0%, P < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14-12.84, P = 0.792; I = 90.5%, P = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59-3.16, P = 0.459; I = 62.0%, P = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention.
CONCLUSION
Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.
Topics: Aged; Coronary Artery Disease; Diabetes Mellitus, Type 2; Humans; Proportional Hazards Models; Sarcopenia
PubMed: 34521369
DOI: 10.1186/s12877-021-02438-w -
The British Journal of Radiology Feb 2024Malnutrition and sarcopenia have been reported to adversely affect the outcome of patients with cirrhosis of the liver. There is an emerging body of evidence suggesting...
OBJECTIVES
Malnutrition and sarcopenia have been reported to adversely affect the outcome of patients with cirrhosis of the liver. There is an emerging body of evidence suggesting malnutrition and sarcopenia increase the risk of hepatic encephalopathy (HE) and mortality after transjugular intrahepatic portosystemic shunt (TIPS). The current systematic review aims to determine whether the body of evidence supports an association between nutritional status and post-TIPS outcomes in patients with cirrhosis.
METHODS
Electronic databases of PubMed, Embase, and Scopus were searched from inception to June 3, 2023, for studies analysing the effect of nutritional status on post-TIPS outcomes in patients with cirrhosis.
RESULTS
A total of 22 studies were included in the systemic review. Assessment of sarcopenia was done by skeletal muscle index (SMI) at the L3 level, transversal psoas muscle thickness, psoas muscle density, malnutrition as per ICD, relative sarcopenia with excess adiposity, lipid profile, controlling nutritional status score, body composition analysis, hospital frailty risk score, and visceral and subcutaneous fat area index. Ten out of 12 studies in this systematic review showed a significant association with the incidence of post-TIPS HE. Thirteen out of 14 studies reported that the presence of malnutrition was associated with increased odds of mortality following TIPS. One study reported sarcopenia as an independent predictor of liver failure, and another study reported that Pre-TIPS SMI was an independent predictor of substantial improvement in post-TIPS SMI.
CONCLUSIONS
The current systematic review shows that the presence of pre-TIPS malnutrition or sarcopenia is an independent predictor of adverse outcomes after TIPS. Incorporating these parameters into present prediction models can provide additional prognostic information.
ADVANCES IN KNOWLEDGE
Nutritional assessment should be part of the evaluation of patients planned for TIPS for prediction of adverse events after the procedure.
Topics: Humans; Sarcopenia; Portasystemic Shunt, Transjugular Intrahepatic; Nutritional Status; Liver Cirrhosis; Hepatic Encephalopathy; Psoas Muscles; Malnutrition; Treatment Outcome; Retrospective Studies
PubMed: 38276881
DOI: 10.1093/bjr/tqad065 -
Oncotarget Nov 2017The impact of sarcopenia on outcomes following treatment for primary liver tumors remains contentious. Therefore, we performed a systematic literature review and...
BACKGROUND
The impact of sarcopenia on outcomes following treatment for primary liver tumors remains contentious. Therefore, we performed a systematic literature review and meta-analysis to evaluate the clinical significance of sarcopenia in the treatment of patients with primary liver tumors.
DATA SOURCES
A systematic literature search was performed in English through February 1, 2017 in databases.
RESULTS
There were significant differences between patients with and without sarcopenia in overall 1- and 3-year survival (1 year: OR: 0.43; 95% CI: 0.27-0.68; =0.0004; 3 year: OR: 0.67; 95% CI: 0.47-0.96; =0.03). However, overall 5-year survival showed no significant difference between the groups (OR: 0.61; 95% CI: 0.35-1.07; =0.08). Patients with sarcopenia showed a significant 53% reduction in disease-free survival within 5 years (OR: 0.47; 95% CI: 0.28-0.79; =0.005). Also, sarcopenia had a significantly negative impact on recurrence in patients with primary liver tumors (RR: 2.71; 95% CI: 1.46-5.05; =0.002). Regarding complications rate, we concluded that there was a statistically significant difference between two groups in overall complications rate (RR: 2.52; 95% CI: 1.50-4.22; =0.0005). However, the major complications rate showed no significant difference between the groups (RR: 1.19; 95% CI: 0.65-2.20; =0.57).
CONCLUSIONS
Sarcopenia seemed to have a negative effect on overall survival in patients with primary liver tumors in the early phase post-treatment, but further research is needed to investigate the prognostic impact on overall survival over the longer term. Moreover, sarcopenia could significantly increase the incidence rates of post-treatment recurrence and overall complications in patients with primary liver tumors.
PubMed: 29254263
DOI: 10.18632/oncotarget.19687 -
Cardiovascular and Interventional... Mar 2019Severe spontaneous soft tissue hematomas (SSTH) are usually treated with transcatheter arterial embolization (TAE) although only limited retrospective studies exist...
BACKGROUND
Severe spontaneous soft tissue hematomas (SSTH) are usually treated with transcatheter arterial embolization (TAE) although only limited retrospective studies exist evaluating this treatment option. The aim of this study was to systematically assess the efficacy and safety of TAE for the management of SSTH.
METHODS
Medline, EMBASE, PubMed and Cochrane Library were searched from inception to July 2017 using MeSH headings and a combination of keywords. Eligibility was restricted to original studies with patients suffering from SSTH treated with TAE. Patients with traumatic hematomas or who were treated with solely conservative or surgical management were excluded. For each publication, clinical success based on the control of the bleed, rebleeding rates and complications (including mortality) was collected, as well as technical details.
RESULTS
Sixty-three studies met the inclusion criteria, with an aggregate total of 267 patients. Follow-up extended from 1 day to 10 years. Bleeding was mainly localized to the iliopsoas (n = 113/267, 42.3%) and anterior abdominal wall (n = 145/266, 54.7%). When information was available, 81.0% (n = 158/195) of patients were on anticoagulant therapy prior to the bleeding episode. Initial stabilization with control of the bleed was obtained in 93.1% (n = 242 patients, n = 60 studies). The most common embolic materials were coils (n = 129, 54.4%). Rebleeding was reported in 25 patients (9.4%). Only two embolization complications were reported (0.7%). The 30-day mortality was 22.7% (n = 42/1857).
CONCLUSION
TAE represents a safe and effective procedure in the management of SSTH. We present a management algorithm based on these data, but further studies are needed to address the knowledge gap.
Topics: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Computed Tomography Angiography; Embolization, Therapeutic; Female; Hematoma; Humans; Male; Middle Aged; Muscle, Skeletal; Muscular Diseases; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30327927
DOI: 10.1007/s00270-018-2086-x