bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Satisfaction is Not Associated With Self-reported Disability in a Spine Patient Population
Authors: Abtahi Amir M. , Lyman Kade Shumway , Brodke Darrel S. , Lawrence Brandon D. , Zhang Chong , Spiker William Ryan 
Published: March 2018

Study Design:
This is a retrospective review.

Objective:
To evaluate the relationship between patient functional status and self-assessment of disability as measured by 3 commonly used clinical assessment instruments—the Oswestry Disability Index (ODI), the Neck Disability Index (NDI), and the EuroQol (EQ)-5D and patient satisfaction scores in a spine surgery clinic population.

Summary of Background Data:
Patient satisfaction surveys, which measure the “patient experience of care” are becoming an increasingly important measure of the quality of medical care. Despite the widespread use of patient satisfaction surveys, little is known about the relationship between patient satisfaction and patient functional status or self-assessed level of disability.

Materials and Methods:
We retrospectively reviewed records of 231 consecutive patients presenting to a single academic spine surgery center between February 2011 and October 2013 who completed both a patient satisfaction survey as well as one or more patient-reported outcome questionnaires (NDI, ODI, and/or EQ-5D) for a single clinical encounter. Statistical analysis was performed to determine if an association exists between the overall patient satisfaction score and each patient-reported outcome score.

Results:
Spearman correlation coefficients demonstrated no correlation between any patient-reported outcome score and the patient satisfaction score [NDI=−0.113 (−0.409 to 0.207) P=0.489] [ODI=−0.008 (−0.149 to 0.133) P=0.912] [EQ-5D=0.011 (−0.119 to 0.140) P=0.872] for a single clinical encounter.

Conclusions:
These results provide evidence against an association between patient-reported functional status or self-assessed level of disability and patient satisfaction in a spine patient population.
Impact of Glycemic Control on Morbidity and Mortality in Adult Idiopathic Scoliosis Patients Undergoing Spinal Fusion
Authors: Shin John I. , Phan Kevin , Kothari Parth , Kim Jun S. , Guzman Javier Z. , Cho Samuel K. 
Published: March 2018

Study Design:
This is a retrospective analysis of administrative database.

Objective:
To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery.

Summary of Background Data:
Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery. Previous studies may have reported higher than true rates of complications for controlled diabetic patients, who are the majority of diabetic patients.

Materials and Methods:
The Nationwide Inpatient Sample was queried from years 2002 to 2011. We extracted idiopathic scoliosis patients older than 45 years of age that received spinal fusion and analyzed complications and outcomes variables among 3 cohorts: nondiabetic patients, controlled diabetics, and uncontrolled diabetics. Multivariate analyses were used to assess whether glycemic control was a risk factor for adverse postoperative outcomes.

Results:
Controlled diabetics had significantly increased rates of acute renal failure (ARF), while uncontrolled diabetics had significantly increased rates of acute postoperative hemorrhage. In multivariate analyses controlling for patient factors and comorbidities, controlled DM was found to be an independent predictor of ARF [odds ratio (OR), 1.863; 95% confidence interval (CI), 1.346–2.579; P=0.0002), and uncontrolled DM was found to be a significant risk factor for acute postoperative hemorrhage (OR, 2.182; 95% CI, 1.192–3.997; P=0.0115), ARF (OR, 4.839; 95% CI, 1.748–13.392; P=0.0024), deep vein thrombosis (OR, 5.825; 95% CI, 1.329–25.522, P=0.0194) and in-patient mortality (OR, 8.889; 95% CI, 1.001–78.945; P=0.0499).

Conclusions:
Controlled DM was found to be a risk factor for ARF in adult idiopathic scoliosis patients undergoing spinal fusion surgery, while uncontrolled DM was shown to be a risk factor for postoperative hemorrhage, ARF, deep vein thrombosis, and mortality. The present study provides valuable data for better informed consent for patients with diabetes considering surgery for idiopathic scoliosis.

Level of Evidence:
Level III.
Obesity as a Risk Factor for Low Back Pain
Authors: Zhang Ting-Ting , Liu Zhen , Liu Ying-Li , Zhao Jing-Jing , Liu Dian-Wu , Tian Qing-Bao 
Published: March 2018

Study Design:
A meta-analysis.

Objective:
To update the current knowledge about the association between overweight, obesity, and low back pain (LBP) risk, we conducted a meta-analysis of published cohort studies.

Summary of Background Data:
The association between obesity and LBP risk has been the research focus in the past decade. However, available data from studies on the association between obesity and LBP remains debatable.

Methods:
An extensive English language literature retrieval regarding the association between overweight, obesity, and the risk of LBP incidence was conducted on PubMed and EMBASE databases through December 2015. Meta-analysis for all the included literature was performed by STATA 12.0 to summarize test performance with Forest plots after a heterogeneity test. Moreover, subgroup and sensitivity analyses were performed to examine the potential candidate-effect factors.

Results:
A total of 10 cohort studies including 29,748 subjects satisfied the predefined eligibility criteria. The pooled odds ratio (OR) for overweight and obesity compared with normal weight was 1.15 [95% confidence interval (CI), 1.08–1.21) and 1.36 (95% CI, 1.18–1.57), respectively. Moreover, subgroup analysis proved that increased body mass index was associated with an increased incidence of LBP in both men (overweight: pooled OR=1.16, 95% CI, 1.04–1.31; obesity: pooled OR=1.36, 95% CI, 1.15–1.61) and women (overweight: pooled OR=1.24, 95% CI, 1.04–1.50; obesity: pooled OR=1.40, 95% CI, 1.08–1.82). There was no evidence of publication bias.

Conclusions:
Our findings consistently show that overweight and obesity are risk factors for LBP in men and women. Maintaining a healthy body weight may be one of the factors preventing the occurrence of LBP.

Level of Evidence:
Level 1.
Comparative Study of the Difference of Perioperative Complication and Radiologic Results
Authors: Jin Jie , Ryu Kyeong-Sik , Hur Jung-Woo , Seong Ji-Hoon , Kim Jin-Sung , Cho Hyun-Jin 
Published: March 2018

Study Design:
Retrospective observatory analysis.

Objective:
The purpose of this study was to compare the incidence of perioperative complication, difference of cage location, and sagittal alignment between minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF) and MIS-direct lateral lumbar interbody fusion (DLIF) in the cases of single-level surgery at L4–L5.

Summary of Background Data:
MIS-DLIF using tubular retractor has been used for the treatment of lumbar degenerative diseases; however, blunt transpsoas dissection poses a risk of injury to the lumbar plexus. As an alternative, MIS-OLIF uses a window between the prevertebral venous structures and psoas muscle.

Materials and Methods:
A total of 43 consecutive patients who underwent MIS-DLIF or MIS-OLIF for various L4/L5 level pathologies between November 2011 and April 2014 by a single surgeon were retrospectively reviewed. A complication classification based on the relation to surgical procedure and effect duration was used. Perioperative complications until 3-month postoperatively were reviewed for the patients. Radiologic results including the cage location and sagittal alignment were also assessed with plain radiography.

Results:
There were no significant statistical differences in perioperative parameters and early clinical outcome between 2 groups. Overall, there were 13 (59.1%) approach-related complications in the DLIF group and 3 (14.3%) in the OLIF group. In the DLIF group, 3 (45.6%) were classified as persistent, however, there was no persistent complication in the OLIF group. In the OLIF group, cage is located mostly in the middle 1/3 of vertebral body, significantly increasing posterior disk space height and foraminal height compared with the DLIF group. Global and segmental lumbar lordosis was greater in the DLIF group due to anterior cage position without statistical significance.

Conclusions:
In our report of L4/L5 level diseases, the OLIF technique may decrease approach-related perioperative morbidities by eliminating the risk of unwanted muscle and nerve manipulations. Using orthogonal maneuver, cage could be safely placed more posteriorly, resulting in better disk and foraminal height restoration.
Outcome of Decompression Alone for Foraminal/Extraforaminal Entrapment of L5 Nerve Root Through Wiltse Paraspinal Approach
Authors: Choi Kyung-Chul , Kim Jin-Sung , Lee Dong Chan , Park Choon-Keun 
Published: March 2018

Study Design:
Retrospective analysis.

Objective of the Study:
The objective of the study was to present the surgical outcome and analyze the prognostic factors for postoperative leg pain after posterior decompression alone for foraminal/extraforaminal L5 entrapment at L5–S1 segment (LSS).

Summary of Background Data:
Disk extrusion, hypertrophy of facet joint, osteophyte of vertebral body, thickened lumbosacral ligament, and collapsed disk lead to form the lumbosacral tunnel which compresses the L5 exiting nerve root. There are few reports discussing the outcome and prognostic factors of posterior decompression alone.

Materials and Methods:
One hundred two consecutive patients underwent posterior decompressive surgery through Wiltse approach for foraminal/extraforaminal entrapment at LSS, performed by 2 surgeons. Demography and preoperative radiograph were analyzed for 6 parameters: age, pathology, disk height, relative disk height ratio, depth of L5 vertebrae within the pelvis, and coronal wedging angle of the segment. Clinical outcomes were assessed by the Visual Analog Scale score for back and leg pain, Oswestry Disability Index, and modified Macnab criteria. The incidence of medications of anticonvulsants, opioids, epidural nerve root block and revisional surgery at index level were also examined.

Results:
This study included 93 patients. The mean follow-up period was 40.6±19.7 months. Thirty-six patients had disk herniation and 57 had stenosis. Preoperative Visual Analog Scale score and Oswestry Disability Index significantly improved at the final follow-up. On the basis of the modified Macnab criteria, 83% of the patients had good outcomes at follow-up. The mean duration of the medications of anticonvulsants or opioids is 27.2±37.4 days (0–210 d). 5 patients (5.4%) were reoperated. Relative disk height ratio <0.8 was associated with worsening of postoperative leg pain (P<0.01).

Conclusions:
Decompression as the only method for foraminal/extraforminal lesion of LSS through Wiltse paraspinal approach provided good clinical results. A large difference of disk height between standing and supine positions is associated with poor clinical outcomes.
Patient Factors Contributing to Prolonged Postoperative Length of Stay and Increased Rate of Readmission After Elective Posterior Cervical Fusion
Authors: Shin John I. , Kim Jun S. , Steinberger Jeremy , DiCapua John , Cho Samuel K. 
Published: March 2018

Study Design:
This is retrospective study of prospectively collected data.

Objective:
To identify patient factors that are independently associated with prolonged length of stay (LOS) and readmission after posterior cervical fusion (PCF) utilizing a large national database.

Summary of Background Data:
A number of studies have investigated the morbidity and mortality after PCF; however, little is known about the factors that are associated with prolonged LOS and readmission, both of which incur increased costs for patients and hospitals.

Methods:
The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2014. Current Procedural Terminology code 22600 was used to identify patients who underwent PCF. All patient factors were assessed for association with LOS and readmission rate using bivariate and multivariate logistic regressions.

Results:
A total of 2667 patients who underwent PCF met the inclusion criteria for LOS analysis. Average (±SD) LOS was 3.92 (±3.24) days, and median LOS was 3 days (interquartile range, 2–5 d). On multivariate analysis, increased LOS was found to be significantly associated with dependent functional status (P<0.001), diabetes mellitus (P=0.021), preoperative anemia (P=0.001), American Society of Anesthesiologists class 3 or 4 (P<0.001), and number of fused levels (P<0.001). A total of 2591 patients met criteria (LOS≤11 d) for analysis of readmission. Readmission rate among these patients was 7.1%. Average (±SD) LOS of the patients not readmitted within 30 days of operation was 3.89 (±3.25), whereas the average (±SD) LOS of the patients readmitted was 4.24 (±3.08). On multivariate analysis, readmission was found to be significantly associated with only dependent functional status (P=0.019) and increased number of fused levels (P=0.032).

Conclusions:
The current study provides valuable information on patient factors that are associated with prolonged LOS and readmission, which would be useful in enhanced informed consent before surgery, surgical planning, discharge planning, and optimizing postoperative care.

Level of Evidence:
Level III.
Clinical Outcomes After Posterior Lumbar Interbody Fusion
Authors: Takenaka Shota , Mukai Yoshihiro , Tateishi Kosuke , Hosono Noboru , Fuji Takeshi , Kaito Takashi 
Published: March 2018

Study Design:
This study is a retrospective cohort study using prospectively collected data.

Objective:
To compare the effectiveness of posterior lumbar interbody fusion (PLIF) using the cortical bone trajectory (CBT) and conventional pedicle screw (PS) techniques.

Summary of Background Data:
There are few published studies to date comparing PLIF using CBT technique with PLIF using the conventional PS technique.

Methods:
We studied 119 consecutive patients who underwent single-level PLIF between 2010 and 2014 with a minimum 12-month follow-up. Forty-two patients underwent CBT-PLIF (the CBT group) and 77 underwent conventional PS-PLIF (the PS group). Clinical outcomes were assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analog scale (VAS). To assess perioperative pain, a 6-point Numeric Rating Scale score and the total amount of diclofenac sodium suppositories used were recorded. The operative time and blood loss were recorded. Muscle damage was evaluated by serum creatine kinase concentrations. Fusion status was evaluated using 3-dimensional computed tomography 12 months postoperatively. We used inverse probability of treatment weighting based on the propensity score to reduce confounding factors.

Results:
There were no significant between-group differences in operative time or fusion rates, whereas the CBT group experienced significantly less blood loss, lower postoperative creatine kinase levels, less diclofenac sodium suppositories, and lower Numeric Rating Scale scores than the PS group did. The change in the JOABPEQ subdomain score for social life function 1 month postoperatively was the only significantly different factor among the JOABPEQ and VAS scores.

Conclusions:
Both procedures were comparable in terms of clinical outcomes and fusion rates, but CBT-PLIF provided the additional benefits of less blood loss, less intraoperative muscle damage, less perioperative pain, and earlier recovery to normal activities.
Symptomatic Adjacent Segment Disease After Anterior Cervical Discectomy for Single-level Degenerative Disk Disease
Authors: Donk Roland D. , Verhagen Wim I. M. , Hosman Allard J. F. , Verbeek Andre , Bartels Ronald H.M.A. 
Published: March 2018

Study Design:
A prospective cohort of 142 patients underwent either anterior cervical discectomy alone, anterior cervical discectomy with fusion by cage stand-alone, or anterior cervical discectomy with arthroplasty. We then followed up on their condition for a mean of 9.1±1.9 years (5.6–12.2 y) later.

Objective:
We aimed to evaluate the annual rate of clinically symptomatic adjacent segment disease (ASD) and to analyze predictive factors.

Summary of Background Data:
Until recent, ASD has been predominantly evaluated radiologically. It is not known whether all patients had complaints. A frequent cited annual rate of ASD is 2.9%, but a growing number of studies report a lower annual rate. Furthermore, maintaining motion to prevent ASD is one reason for implanting a cervical disk prosthesis. However, the results of studies contradict one another.

Methods:
Participants took part in a randomized controlled trial that ended prematurely because of the publication of evidence that did not justify continuation of the trial. The patients were randomly allocated to 3 groups, each of which received one of the abovementioned treatments. We defined symptomatic ASD as signs and symptoms caused by degeneration of an intervertebral disk adjacent to a level of previous anterior cervical disk surgery. At the last follow-up, we were able to ascertain whether clinically symptomatic ASD was present in any of the participants.

Results:
The overall annual rate of symptomatic ASD was 0.7%. We found no statistically significant correlations between any of the investigated factors and symptomatic ASD except for the surgical method used. Symptomatic ASD was seen less often in anterior cervical discectomy solely or anterior cervical discectomy with arthroplasty than in anterior cervical discectomy with fusion by plate fixation.

Conclusions:
The annual rate of symptomatic ASD after an anterior cervical discectomy procedure was estimated to be 0.7%. This seems to be related to the procedure, although firm conclusions cannot be drawn.

Level of Evidence:
Level 2—prospective cohort.
Novel Angular Measures of Cervical Deformity Account for Upper Cervical Compensation and Sagittal Alignment
Authors: Protopsaltis Themistocles S. , Lafage Renaud , Vira Shaleen , Sciubba Daniel , Soroceanu Alex , Hamilton Kojo , Smith Justin , Passias Peter G. , Mundis Gregory , Hart Robert , Schwab Frank , Klineberg Eric , Shaffrey Christopher , Lafage Virginie , Ames Christopher 
Published: March 2018

Study Design:
This is a retrospective review of a prospective multicenter database.

Objective:
This study introduces 2 new cervical alignment measures accounting for both cervical deformity (CD) and upper cervical compensation.

Summary of Background Data:
Current descriptions of CD like the C2–C7 sagittal vertical axis (cSVA) do not account for compensatory mechanisms such as C0–C2 lordosis and pelvic tilt, which makes surgical planning difficult. The craniocervical angle (CCA) combines the slope of McGregor’s line and the inclination from C7 to the hard palate. The C2-pelvic tilt (CPT) combines C2 tilt and pelvic tilt. Like the T1 pelvic angle, CPT is less affected by lower extremity and pelvic compensation.

Methods:
Novel and existing CD measures were correlated in 781 patients from a thoracolumbar deformity (TLD) database and 61 patients from a prospective CD database. CD patients were subanalyzed by region of deformity driver: cervical or cervico-thoracic junction. TLD patients were substratified according to whether or not they had CD as well, where CD was defined as cSVA>4 cm or T1 slope minus cervical lordosis mismatch (TS-CL) >20.

Results:
TLD cohort: mean cSVA was 31.7±17.8 mm. Subanalysis of TLD patients with CD versus no-CD demonstrated significant differences in CCA (56.2 vs. 60.6, P<0.001) and CPT (32.6 vs. 19.3, P<0.001). CCA and CPT correlated with cSVA (r=−0.488/r=0.418, P<0.001) and C0–C2 lordosis (r=−0.630/r=0.289,P<0.001). CD cohort: mean cSVA was 47.3±32.2 mm. CCA and CPT correlated with cSVA (r=−0.811/r=0.657, P<0.001) and C0–C2 lordosis (r=−0.656/r=0.610, P<0.001). CD cohort subanalysis indicated that CT patients were significantly more deformed by cSVA (71.3 vs 24.0 mm, P<0.001), CCA (47.1 vs 59.1 degrees, P<0.001), and CPT (63.3 vs 43.8 degrees, P=0.002). Using linear regression analysis, cSVA of 4 cm corresponded to CCA of 53.2 degrees (r
2=0.5) and CPT of 48.5 degrees (r
2=0.4).

Conclusions:
CCA and CPT account for both cervical sagittal alignment and upper cervical compensation and can be utilized in assessment of cervical alignment.
Reliability and Clinical Utility of the CARDS Classification for Degenerative Spondylolisthesis
Authors: Sobol Garret L. , Hilibrand Alan , Davis Ashley , Millhouse Paul , Koerner John , Kepler Christopher , Schroeder Gregory D. , Krystal Jonathan D. , Olsson Erik C. , Rihn Jeffrey , Anderson David Greg , Vaccaro Alexander , Radcliff Kristen 
Published: March 2018

Study Design:
Retrospective cohort study.

Objective:
The objective of this study is to determine the reliability and clinical utility of the of the proposed CARDS classification for degenerative spondylolisthesis.

Background:
The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system was recently proposed as an alternative to the Meyerding system for classifying degenerative spondylolisthesis (DS). Unlike Meyerding, CARDS considers other relevant radiographic findings such as disk space collapse and segmental kyphosis to stratify DS into 4 radiographically discreet types. Currently, no studies have been conducted to assess the clinical utility of the CARDS system.

Methods:
A total of 78 consecutive surgical patients with L4-L5 DS were rated as CARDS types A through D and Fleiss’ κ for interobserver agreement was calculated. Then, demographics as well as preoperative and postoperative outcome scores (ODI, SF-12 mental and physical, VAS) were collected. The Kruskal-Wallis test was used to detect significant differences amongst CARDS types. An unpaired t test was used to compare individual CARDS types with all other subtypes combined.

Results:
Grading showed: 4 type A, 19 type B, 45 type C, and 8 type D (k=0.63). There was a statistically significant difference in preoperative back pain (P=0.046) between groups. CARDS type D had the highest mean back pain scores (8.8) of all subtypes which was significantly higher than mean back pain for all other subtypes combined (P=0.016). CARDS D showed the largest degree of improvement in all outcome measures. There was a trend towards an increased improvement in ODI (P=0.074) and SF-12 MCS (P=0.095) in the CARDS D subtype relative to the rest of the cohort.

Conclusions:
The CARDS classification system represents a reliable method for classifying cases of DS. Our results indicate that kyphotic segmental alignment (CARDS D) may be a less common, yet clinically distinct subset of DS characterized by worse preoperative back pain. CARDS type D cases may also show a greater degree of improvement in multiple outcome measures following surgical intervention.