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Asian Spine Journal Jun 2024A retrospective cohort study using the Kaplan-Meier method with propensity-score matching.
Prevalent morphometric vertebral fractures as a risk factor for subsequent clinical vertebral fractures after shortfusion surgery in older Japanese women with degenerative spondylolisthesis.
STUDY DESIGN
A retrospective cohort study using the Kaplan-Meier method with propensity-score matching.
PURPOSE
To evaluate whether the presence of prevalent morphometric vertebral fractures (VFs) poses a risk for subsequent clinical VFs after short-fusion surgery in women aged ≥60 years with degenerative spondylolisthesis.
OVERVIEW OF LITERATURE
VFs are common osteoporotic fractures and are associated with a low quality of life. Subsequent VFs are a complication of instrumented fusion in patients with degenerative lumbar disorders. Thus, risk factors for subsequent VFs after fusion surgery must be analyzed. Population-based studies have suggested that prevalent morphometric VFs led to a higher incidence of subsequent VFs in postmenopausal women; however, no studies have investigated whether prevalent morphometric VFs are a risk factor for subsequent VFs after fusion surgery in patients with degenerative spondylolisthesis.
METHODS
The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [-] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (-) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis.
RESULTS
Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (-) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching.
CONCLUSIONS
The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.
PubMed: 38917857
DOI: 10.31616/asj.2023.0327 -
Journal of Strength and Conditioning... Jun 2024Ramirez, VJ, Bazrgari, B, Spencer, A, Gao, F, and Samaan, MA. Influence of repetitions-to-failure deadlift on lumbo-pelvic coordination, with and without body armor. J...
Ramirez, VJ, Bazrgari, B, Spencer, A, Gao, F, and Samaan, MA. Influence of repetitions-to-failure deadlift on lumbo-pelvic coordination, with and without body armor. J Strength Cond Res XX(X): 000-000, 2024-Repetition-to-failure (RTF) deadlift is a training modality for building lifting capacity that is often implemented by service members to maintain a minimum level of physical fitness. Despite its physiological benefits, little is known about the effects of RTF on the biomechanics of lumbar spine. Additionally, the effects of heavy deadlift training with body armor are unknown. The aim of this study was to investigate the effects of RTF deadlift on lumbo-pelvic coordination and posture, with and without body armor. Twenty-three healthy subjects, recreational powerlifters, were recruited for this study. Kinematics of the trunk and pelvis were measured using a 3D motion capture system while subjects conducted RTF deadlifts with a 68-kg low-handle hexagonal bar with and without a simulated body armor (22.68 kg). Lumbo-pelvic coordination was characterized using a vector coding approach and coupling angle variability (CAV) using circular statistics, over 3 equally divided segments of the lifting phase. More specifically, the coupling angle values were used to determine the coordination pattern between the thorax and pelvis. Trunk and pelvis ranges of motion and the amount of in-phase lumbo-pelvic coordination pattern increased with RTF deadlift. Additionally, CAV of the first and the third segments of deadlift cycle increased with RTF deadlift. Increase in variability of lumbo-pelvic coordination and peak trunk flexion (i.e., indication of increased mechanical demand of lifting on the spine), as a result of RTF deadlifting, can have deleterious soft tissue responses and contribute to an increase in risk of lower back injury.
PubMed: 38917029
DOI: 10.1519/JSC.0000000000004871 -
JAMA Network Open Jun 2024Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work.
IMPORTANCE
Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work.
OBJECTIVE
To estimate the association of SCI with individual earnings and employment status using national administrative health databases linked to income tax data.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective, national, population-based cohort study of adults who were hospitalized with cervical SCI in Canada between January 2005 and December 2017. All acute care hospitalizations for SCI of adults ages 18 to 64 years were included. A comparison group was constructed by sampling from individuals in the injured cohort. Fiscal information from their preinjury years was used for comparison. The injured cohort was matched with the comparison group based on age, sex, marital status, province of residence, self-employment status, earnings, and employment status in the year prior to injury. Data were analyzed from August 2022 to January 2023.
MAIN OUTCOMES AND MEASURES
The first outcome was the change in individual annual earnings up to 5 years after injury. The change in mean yearly earnings was assessed using a linear mixed-effects differences-in-differences regression. Income values are reported in 2022 Canadian dollars (CAD $1.00 = US $0.73). The second outcome was the change in employment status up to 5 years after injury. A multivariable probit regression model was used to compare proportions of individuals employed among those who had experienced SCI and the paired comparison group of participants.
RESULTS
A total of 1630 patients with SCI (mean [SD] age, 47 [13] years; 1304 male [80.0%]) were matched to patients in a preinjury comparison group (resampled from the same 1630 patients in the SCI group). The mean (SD) of preinjury wage earnings was CAD $46 000 ($48 252). The annual decline in individual earnings was CAD $20 275 (95% CI, -$24 455 to -$16 095) in the first year after injury and CAD $20 348 (95% CI, -$24 710 to -$15 985) in the fifth year after injury. At 5 years after injury, 52% of individuals who had an injury were working compared with 79% individuals in the preinjury comparison group. SCI survivors had a decrease in employment of 17.1 percentage points (95% CI, 14.5 to 19.7 percentage points) in the first year after injury and 17.8 percentage points (14.5 to 21.1 percentage points) in the fifth year after injury.
CONCLUSIONS AND RELEVANCE
In this study, SCI was associated with a decline in earnings and employment up to 5 years after injury for adults aged 18 to 64 years in Canada.
Topics: Humans; Spinal Cord Injuries; Male; Female; Adult; Employment; Middle Aged; Income; Retrospective Studies; Canada; Young Adult; Adolescent; Cervical Cord
PubMed: 38916890
DOI: 10.1001/jamanetworkopen.2024.18468 -
Journal of Neurosurgical Sciences Jun 2024Acute traumatic spinal cord injury (tSCI) requires rapid surgical intervention to maximize neurological function. Older patients comprise an increasingly larger...
BACKGROUND
Acute traumatic spinal cord injury (tSCI) requires rapid surgical intervention to maximize neurological function. Older patients comprise an increasingly larger proportion of SCI patients annually, necessitating accurate preoperative risk stratification tools. This study utilized a frailty-based preoperative risk stratification score to predict adverse events following non-elective neurosurgical intervention for acute tSCI patients.
METHODS
The National Inpatient Sample (NIS) was queried for acute tSCI patients aged ≥18 who underwent spine surgery in 2019-2020. The Risk Analysis Index (RAI) was implemented with crosstabulation, to analyze frailty scores with the following binary outcome measures: overall complications, non-home discharge (NHD), extended length of stay (eLOS) (>75 percentile), and mortality. Area Under the Receiver Operating Characteristic (AUROC) analysis assessed the discriminative threshold of RAI compared to the modified 5-item Frailty Index (mFI-5) for NHD and 30-day mortality.
RESULTS
A total of 9995 SCI patients underwent non-elective spine surgery. There were 1525 perioperative complications (15.3%) and 510 (5.1%) mortalities. An increasing RAI score was significantly associated with increasing postoperative mortality rates: RAI 0-20 (1.5%, N.=45), RAI 21-30 (3.4%, N.=110), RAI 31-40 (6.8%, N.=115), and RAI>41 (11.8%, N.=240) (P<0.001). RAI demonstrated superior discrimination compared to the mFI-5 for mortality and NHD with a C-statistic >0.72.
CONCLUSIONS
Increasing frailty, as measured by RAI, was a reliable predictor of non-home discharge and 30-day mortality for SCI patients who underwent non-elective spinal surgery and RAI demonstrated superior discrimination compared to the mFI-5 for NHD and mortality.
PubMed: 38916577
DOI: 10.23736/S0390-5616.24.06189-7 -
Drug Design, Development and Therapy 2024Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC)...
Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury?
INTRODUCTION
Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted.
METHODS
We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery.
RESULTS
Fifty-four patients were included in this study. The EC was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness.
CONCLUSION
The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.
Topics: Ropivacaine; Humans; Male; Middle Aged; Female; Lumbar Vertebrae; Adult; Anesthetics, Local; Anesthesia, Epidural; Diskectomy, Percutaneous; Endoscopy; Spinal Nerve Roots; Dose-Response Relationship, Drug; Sensation; Aged
PubMed: 38915867
DOI: 10.2147/DDDT.S451980 -
PeerJ 2024An interesting and little-reported problem in the literature is the scale of asymmetry in table tennis players, the magnitude of which should perhaps be treated as a...
BACKGROUND
An interesting and little-reported problem in the literature is the scale of asymmetry in table tennis players, the magnitude of which should perhaps be treated as a risk for injury. Determining the degree of asymmetry in table tennis players can indicate the need to appropriately manage the training process, including compensatory or corrective exercises in the training program, especially since recent studies confirm that training interventions can reduce sporting asymmetries and improve performance. This study aimed to assess the amount of asymmetry in the trunk regarding the frontal plane and the difference between limb circumferences in female table tennis players compared to the control group (non-athletes).
METHODS
Twenty-two women took part in the study. Ten of them were table tennis professionals with an average training experience of 7 ± 4.3 years (the exclusion criterion of the study was a minimum of 3 years of training experience). As a comparison group, the study included 12 female students who did not participate in competitive sports. Body posture was assessed in all subjects using equipment for computer analysis of asymmetry in the torso using the photogrammetric method. Additionally, all the subjects had their upper and lower limb circumferences measured.
RESULTS
The results of the conducted research showed asymmetry in the frontal plane in the table tennis player group. As many as six parameters-regarding the pelvic rotation angle, angle of trunk inclination, the height of the angles of the lower shoulder blades and their distance from the spine, as well as the waist triangles, difference in the width and height of the waist triangles and the angle of trunk inclination-indicated asymmetry in this group but significantly differed from the control group ( ≤ 0.05) only in the first parameter given above. The calculated differences in circumference between the right and left sides in the individual groups were statistically different in several cases ( ≤ 0.05). This concerned the circumferences of the arms, forearms, elbows, and knees of table tennis players.
CONCLUSIONS
The research carried out in this study allowed us to determine the occurrence of asymmetry in the frontal plane of the trunk and between the limbs of table tennis players. According to some studies, this may be a risk factor for injury. However, despite the lack of uniform views in the literature on the importance and threats resulting from asymmetries, it appears that, if only for aesthetic reasons, table tennis would require compensatory or corrective training aimed at developing symmetry of the body structure.
Topics: Humans; Female; Torso; Young Adult; Tennis; Adult; Posture; Athletes
PubMed: 38915380
DOI: 10.7717/peerj.17526 -
Spinal Cord Jun 2024Cross-sectional study.
STUDY DESIGN
Cross-sectional study.
OBJECTIVES
To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries.
SETTING
SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand.
METHODS
Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression.
RESULTS
Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence.
CONCLUSIONS
Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.
PubMed: 38914754
DOI: 10.1038/s41393-024-01003-7 -
International Journal of Biological... Jun 2024Acquiring rapid and effective hemostasis remains a critical clinical challenge. Current researches focus on concentrating blood components to speed up the hemostatic...
Acquiring rapid and effective hemostasis remains a critical clinical challenge. Current researches focus on concentrating blood components to speed up the hemostatic while ignore the effect of anti-fibrinolysis in promoting blood coagulation. Herein, we designed a novel tranexamic acid (TA)-loaded physicochemical double cross-linked multifunctional catechol-modified hyaluronic acid-dopamine/carboxymethyl chitosan porous gel micropowders (TA&Fe@HA-DA/CMCS PGMs) for rapid hemostasis and wound healing. TA&Fe@HA-DA/CMCS PGMs exhibited high water absorption rate (505.9 ± 62.1 %) and rapid hemostasis (79 ± 4 s) in vivo. Catechol groups, Fe and the protonated amino groups of CMCS induced bacterial death. Moreover, TA&Fe@HA-DA/CMCS PGMs displayed sufficient adhesion to a variety of wet rat tissues. TA&Fe@HA-DA/CMCS PGMs on various bleeding wounds, including rat liver injury and tail severed models showed excellent hemostasis performance. The TA&Fe@HA-DA/CMCS PGMs could promote the healing of full-thickness skin wounds on the backs of rats. The advantages of TA&Fe@HA-DA/CMCS PGMs including rapid hemostasis, effective wound healing, good tissue adhesion, antibacterial properties and ease of use make it potentially valuable in clinical application.
PubMed: 38914405
DOI: 10.1016/j.ijbiomac.2024.133363 -
The Spine Journal : Official Journal of... Jun 2024Large annulus fibrosus (AF) defects often lead to a high rate of reherniation, particularly in the medial AF region, which has limited self-healing capabilities. The...
BACKGROUND CONTEXT
Large annulus fibrosus (AF) defects often lead to a high rate of reherniation, particularly in the medial AF region, which has limited self-healing capabilities. The increasing prevalence of herniated discs underscores the need for effective repair strategies.
PURPOSE
The objectives of this study were to design an AF repair technique to reduce solve the current problems of insufficient mechanical properties and poor sealing capacity.
STUDY DESIGN
In vitro biomechanical experiments and finite element analysis.
METHODS
The materials used in this study were patches and hydrogels with good biocompatibility and sufficient mechanical properties to withstand loading in the lumbar spine. Five repair techniques were assessed in this study: hydrogel filler (HF), AF patch medial barrier (MB), AF patch medial barrier and hydrogel filler (MB&HF), AF patch medial-lateral barrier (MLB), and AF patch medial-lateral barrier and hydrogel filler (MLB&HF). The repair techniques were subjected to in vitro testing (400 N axial compression and 0-500 N fatigue loading at 5Hz) and finite element analysis (400 N axial compression) to evaluate the effectiveness at repairing large AF defects. The evaluation included repair tightness, spinal stability, and fatigue resistance.
RESULTS
From the in vitro testing, the failure load of the repair techniques was in the following order HF < MB < MB&HF < MLB < MLB&HF. Both HF and MB groups failed to effectively increase intervertebral disc (IVD) stiffness, resulting in a reduction in spatial stability. The MLB, MB&HF, and MLB&HF groups partially restored IVD stiffness, with MLB&HF showing the most effective recovery (-24.13% ± 3.59%). From the finite element models, incorporating a hydrogel filler was best able to maintain the IVD height. Patch repair alone could not adequately reduce the high AF stress due to AF injury, but with hydrogel support, stress was substantially low and more uniformly distributed. All repair techniques demonstrated reduced stress around the damaged area on the AF, in comparison to the unrepaired model. The NP pressure in the HF group was closest to the intact group, and the patch repair reduced the NP pressure. The maximum patch deformation and suture stress were ranked as MB > MLB > MB&HF > MLB&HF.
CONCLUSIONS
The combined use of patches and hydrogels exhibited promising mechanical properties post-discectomy, providing a promising solution for addressing large AF defects and improving disc stability.
CLINICAL SIGNIFICANCE
This study introduces a promising method for repairing large annular fissure (AF) defects after disc herniation, combining patch repair with a hydrogel filler. These techniques hold potential for developing clinical AF repair products to address this challenging issue.
PubMed: 38914373
DOI: 10.1016/j.spinee.2024.06.013 -
Anasthesiologie, Intensivmedizin,... Jun 2024Neurotrauma results from violence on structures of the central or peripheral nervous system and is a clinically common disease entity with high relevance for patients'... (Review)
Review
Neurotrauma results from violence on structures of the central or peripheral nervous system and is a clinically common disease entity with high relevance for patients' long-term outcome. The application of evidence-based diagnostic and therapeutic concepts aims to minimize secondary injury and thus to improve treatment outcome. This article describes the current management of the two main injury patterns of neurotrauma - traumatic brain and spinal cord injury.
Topics: Humans; Brain Injuries, Traumatic; Spinal Cord Injuries
PubMed: 38914079
DOI: 10.1055/a-2156-6790