bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice Variation Among Surgeons Treating Lumbar Spinal Stenosis in a Single Institution
Authors: Ogink Paul T. , van Wulfften Palthe Olivier , Teunis Teun , Bono Christopher M. , Harris Mitchell B. , Schwab Joseph H. , Cha Thomas D. 
Published: September 2018

Study Design.
A retrospective study.

Objective.
The aim of this study was to examine practice variation in the treatment of lumbar spinal stenosis and identify targets for reducing variation.

Summary of Background Data.
Lumbar spinal stenosis is a degenerative condition susceptible to practice variation. Reducing variation aims to improve quality, increase safety, and lower costs. Establishing differences in surgeons’ practices from a single institution can help identify personalized variation.

Methods.
We identified adult patients first diagnosed with lumbar spinal stenosis between 2003 and 2015 in three hospitals of the same institution with ICD-9 codes.
We extracted number of office visits, imaging procedures, injections, electromyographies (EMGs), and surgery within the first year after diagnosis; physical therapy within the first 3 months after diagnosis. Multivariable logistic regression was used to identify factors associated with surgery. The coefficient of variation (CV) was calculated to compare the variation in practice.

Results.
The 10,858 patients we included had an average of 2.5 visits (±1.9), 1.5 imaging procedures (±2.0), 0.03 EMGs (±0.22), and 0.16 injections (±0.53); 36% had at least one surgical procedure and 32% had physical therapy as part of their care. The CV was smallest for number of visits (19%) and largest for EMG (140%).
Male sex [odds ratio (OR): 1.23, P < 0.001], seeing an additional surgeon (OR: 2.82, P < 0.001), and having an additional spine diagnosis (OR: 3.71, P < 0.001) were independently associated with surgery. Visiting an orthopedic clinic (OR: 0.46, P < 0.001) was independently associated with less surgical interventions than visiting a neurosurgical clinic.

Conclusion.
There is widespread variation in the entire spectrum of diagnosis and therapy for lumbar spinal stenosis among surgeons in the same institution. Male gender, seeing an additional surgeon, having an additional spine diagnosis, and visiting a neurosurgery clinic were independently associated with increased surgical intervention. The main target we identified for decreasing variability was the use of diagnostic EMG.

Level of Evidence: 3
Comparing the Diagnostic Accuracies of F-18 Fluorodeoxyglucose Positron Emission Tomography and Magnetic Resonance Imaging for the Detection of Spondylodiscitis
Authors: Kim Seong-Jang , Pak Kyoungjune , Kim Keunyoung , Lee Jung Sub 
Published: September 2018

Study Design.
A meta-analysis.

Objective.
The aim of this study was to compare the diagnostic accuracies of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) for the detection of spondylodiscitis through a meta-analysis.

Summary of Background Data.
There is no meta-analysis study that compares the diagnostic accuracies of F-18 FDG PET and MRI for the detection of spondylodiscitis.

Methods.
The MEDLINE and EMBASE databases were searched from the earliest available date of indexing to January 10, 2018 for studies comparing the diagnostic performance F-18 FDG PET with that of MRI for the detection of spondylodiscitis. We determined the sensitivities and specificities across studies, calculated the positive and negative likelihood ratios (LR+ and LR−), and constructed the summary receiver operating characteristic curves.

Results.
In the seven studies (212 patients) selected, the pooled sensitivity and specificity of F-18 FDG PET were 0.95 (95% confidence interval [CI]: 0.87–0.98) and 0.88 (95% CI: 0.73–0.95), respectively. The LR syntheses showed an overall LR+ of 7.6 (95% CI: 3.4–17.2) and LR− of 0.05 (95% CI: 0.02–0.14). The pooled diagnostic odds ratio was 141 (95% CI: 44–444). The pooled sensitivity and specificity of MRI were 0.85 (95% CI: 0.65–0.95) and 0.66 (95% CI: 0.48–0.80), respectively. The LR syntheses showed an overall LR+ of 2.5 (95% CI: 1.5–4.2) and LR− of 0.22 (95% CI: 0.08–0.60). The pooled diagnostic odds ratio was 11 (95% CI: 3–42). In the meta-regression analysis, no variable was identified as the source of the study heterogeneity.

Conclusion.
The current meta-analysis shows that F-18 FDG PET has better diagnostic accuracy than MRI for the detection of spondylodiscitis. Further large multicenter studies would be necessary to substantiate the diagnostic accuracies of F-18 FDG PET and MRI for spondylodiscitis.

Level of Evidence: 2
Psychometric Properties Study of the Oswestry Disability Index in a Spanish Population With Previous Lumbar Disc Surgery
Authors: Selva-Sevilla Carmen , Ferrara Paula , Gerónimo-Pardo Manuel 
Published: September 2018

Study Design.
Evaluation of the psychometric properties of a questionnaire.

Objective.
To assess the psychometric properties of the Spanish version of the Oswestry Disability Index (ODI) in a Spanish population with previous lumbar disc surgery.

Summary of Background Data.
ODI is frequently used for measuring disability in spinal disorders. In 1995, ODI was translated and transculturally adapted into the Spanish context; its content and apparent validity, internal consistency and test–retest reliability were demonstrated for a Spanish population with lumbar pain. However, this score has not been tested in terms of discriminative capacity (floor and ceiling effects) and construct validity.

Methods.
Two hundred seventy-five patients who had previously undergone surgical treatment for disc lumbar herniation completed the ODI, Short-Form 36 (SF36), EuroQol-5D (EQ5D), and Numerical Rating Scale for Back Pain. Internal consistency, floor and ceiling effects and construct validity (convergent, divergent, and “known-groups” validities) were assessed.

Results.
Spanish ODI showed a very good internal consistency: Cronbach-α coefficient for ODI score was 0.928; Cronbach-α coefficient, if the item was deleted, did not increase by more than 0.1 for each item; and Item-total correlations ranged from strong to very strong. There was floor effect for both ODI score and for all individual items. There was no ceiling effect. Spanish ODI showed very good construct validity because 88% (7/8) of the hypotheses about convergent, divergent and “known-groups” validities were supported. Concerning convergent validity, ODI was strongly correlated with the Numerical Rating Scale for Back Pain (0.717; P < 0.001), SF36-Utility (rho = −0.786; P < 0.001), Physical Component Summary score SF36 (rho = −0.787; P < 0.001), Mental Component Summary score SF36 (rho = −0.605; P < 0.001), EQ5D-Utility (rho = −0.833; P < 0.001) and some EQ5D physical components.

Conclusion.
Spanish ODI showed good psychometric properties (internal consistency and construct validity), similar to others validation studies. Spanish ODI is a valid instrument for the measurement of disability in Spanish patients with previous lumbar disc surgery, specifically in patients with moderate/intense disability.

Level of Evidence: 4
Preoperative Age and Prognostic Nutritional Index Are Useful Factors for Evaluating Postoperative Delirium Among Patients With Adult Spinal Deformity
Authors: Oe Shin , Togawa Daisuke , Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Kobayashi Sho , Yasuda Tatsuya , Banno Tomohiro , Arima Hideyuki , Mihara Yuki , Ushirozako Hiroki , Yamada Tomohiro , Matsuyama Yukihiro 
Published: September 2018

Study Design.
A retrospective study of postoperative delirium after adult spinal deformity (ASD) surgery.

Objective.
To identify the risk factors of post-ASD surgery delirium, including nutritional state before surgery.

Summary of Background Data.
Recently, malnutrition was reported as one of the risk factors of delirium. The prognostic nutritional index (PNI) and controlling nutritional status index (CONUT) scores are simple methods of nutritional evaluation. However, there are no reports that verify that delirium is related to the PNI and CONUT score in patients who have undergone ASD surgery.

Methods.
A consecutive 319 patients who underwent ASD surgery were divided into a delirium group (group D) or nondelirium group (group ND). Preoperative risk factors, including PNI, were assessed.

Results.
Group D consisted of 30 patients and group ND consisted of 289 patients. There was significant difference in age (group D:group ND = 73:62, P = 0.000), serum albumin (4.2:4.3, P = 0.028), operative time (422:395 min, P = 0.029), PNI score (49:52, P = 0.011), and CONUT score (1.7:1.1, P = 0.046). Using multiple logistic regression analysis, we found significant risk factors for delirium to be age (P = 0.006, odds ratio = 1.11, 95% confidence interval = 1.03–1.19) and PNI (P = 0.003, odds ratio = 0.87, 95% confidence interval = 0.79–0.96). A receiver operating characteristic curve showed that the cut-off value of PNI and age for delirium were 49.7 and 68.5 years, respectively.

Conclusion.
The risk factors of postoperative delirium after ASD surgery were PNI less than 49.7 and age more than 68.5 years. Patients who undergo ASD surgery beyond these preoperative cut-off values should be cautioned about delirium and be required to provide adequate informed consent.

Level of Evidence: 3
Changes in the Sagittal Cranio-Cervical Posture Following a 12-Week Intervention Using a Simple Spinal Traction Device
Authors: Shahar David , Sayers Mark G.L. 
Published: September 2018

Study Design.
Non-controlled clinical trial.

Objective.
To assess the efficacy of a simple home spinal traction device on sagittal cranio-cervical posture and related symptoms.

Summary of Background Data.
Forward head protraction (FHP) and cranio-cervical malalignment were shown to be consequential in the development adverse musculoskeletal radiographic findings and symptoms in that region.

Methods.
Participants (n = 13, 18–36-year-old) were drawn from a mildly symptomatic population, all presented with cranio-cervical malalignment and considerable FHP. Participants used a simple home spinal traction device for 12 weeks, 10 min/d. Sagittal cervical radiographs and the SF36 health survey were obtained pre/post intervention and guideline compliance was recorded. Radiographic evaluation included typical measurements of sagittal cranio-cervical alignment and FHP (e.g., atlas plane line, vertical axis line, sagittal cranial angle, absolute rotation angle). Standard paired samples t tests, chi-squared, and effect size analyses were used to assess pre- and post-intervention changes.

Results.
Each of the key radiographic variables recorded significant moderate to very large positive changes as a result of the intervention. Similarly, Chi-squared analyses indicated that saggital cervical spine configuration tended to become more lordotic (P = 0.007), with four participants shifting from a kyphotic to a lordotic presentation. SF36 health survey data demonstrated mostly significant positive changes throughout all tested domains, and moderate positive changes were recorded across all radiographic cranio-cervical mesured paramenters (e.g., decreased FHP, increased cervical lordosis, and cranial extention). Participants indicated high level of protocol compliance.

Conclusion.
This study has demonstrated that the unsupervised daily use of a simple home spinal traction device (Thoracic Pillow®) proved effective in bringing positive plastic changes to the sagittal cranio-cervical alignment and reduction in symptoms in the tested population during a short intervention period.

Level of Evidence: 3
Predictive Model for Medical and Surgical Readmissions Following Elective Lumbar Spine Surgery
Authors: Sivaganesan Ahilan , Zuckerman Scott , Khan Inamullah , Nian Hui , Harrell Frank E. , Pennings Jacquelyn S. , Harbaugh Robert , Foley Kevin T. , Bydon Mohamad , Asher Anthony L. , Devin Clinton J. , Archer Kristin R. 
Published: September 2018

Study Design.
This study retrospectively analyzes prospectively collected data.

Objective.
Here we aim to develop predictive models for 3-month medical and surgical readmission after elective lumbar surgery, based on a multi-institutional, national spine registry.

Summary of Background Data.
Unplanned readmissions place considerable stress on payers, hospitals, and patients. Medicare data reveals a 30-day readmission rate of 7.8% for lumbar-decompressions and 13.0% for lumbar-fusions, and hospitals are now being penalized for excessive 30-day readmission rates by virtue of the Hospital Readmissions Reduction Program.

Methods.
The Quality and Outcomes Database (QOD) was queried for patients undergoing elective lumbar surgery for degenerative diseases. The QOD prospectively captures 3-month readmissions through electronic medical record (EMR) review and self-reported outcome questionnaires. Distinct multivariable logistic regression models were fitted for surgery-related and medical readmissions adjusting for patient and surgery-specific variables.

Results.
Of the total 33,674 patients included in this study 2079 (6.15%) reported at least one readmission during the 90-day postoperative period. The odds of medical readmission were significantly higher for older patients, males versus females, African Americans versus Caucasion, those with higher American Society of Anesthesiologists (ASA) grade, diabetes, coronary artery disease, higher numbers of involved levels, anterior only or anterior–posterior versus posterior approach; also, for patients who were unemployed compared with employed patients and those with high baseline Oswestry Disability Index (ODI). The odds of surgery-related readmission were significantly greater for patients with a higher body mass index (BMI), a higher ASA grade, female versus male, and African Americans versus Caucasians; also, for patients with severe depression, more involved spinal levels, anterior-only surgical approaches and higher baseline ODI scores.

Conclusion.
In this study we present internally validated predictive models for medical and surgical readmission after elective lumbar spine surgery. These findings set the stage for targeted interventions with a potential to reduce unnecessary readmissions, and also suggest that medical and surgical readmissions be treated as distinct clinical events.

Level of Evidence: 3
FIVE-YEAR FUNCTIONAL OUTCOMES AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Jonna Gowtham , Thompson Ian A. , Mendel Thomas A. , Kim Stephen J. 
Published: September 2018

Purpose:
To evaluate 5-year functional outcomes involving the inner retina after epiretinal membrane (ERM) surgery.

Methods:
The study eye (SE) and fellow eye (FE) of 20 patients undergoing ERM surgery were examined preoperatively and at 3, 12, 24, 36, 48, and 60 months postoperatively. Retinal nerve fiber layer and ganglion cell–inner plexiform layer (GC-IPL) thicknesses were analyzed using spectral domain optical coherence tomography. Humphrey visual field mean deviation, pattern SD, and qualitative changes were assessed and compared over time.

Results:
Mean GC-IPL thickness in SEs was less than that of FEs at all time points with progressive thinning in SEs after ERM surgery. There was significant thinning of the superotemporal GC-IPL in SEs as compared to FEs at 3 months and 60 months (P < 0.05). Humphrey visual field mean deviation was greater in SEs as compared to FEs but statistically significant only at 0, 12, and 24 months (P < 0.05). Pattern SD increased from baseline in SEs but remained near baseline in FEs.

Conclusion:
Surgical eyes after ERM surgery demonstrated progressive thinning of the GC-IPL and transient worsening trends in Humphrey visual field mean deviation and pattern SD as compared to controls after ERM surgery.
PERIPAPILLARY NEUROVASCULAR COUPLING IN THE EARLY STAGES OF DIABETIC RETINOPATHY
Authors: Rodrigues Tiago M. , Marques João P. , Soares Mário , Dolan Michael-John , Melo Pedro , Simão Sílvia , Teles João , Figueira João , Murta Joaquim N. , Silva Rufino 
Published: September 2018

Purpose:
To study radial peripapillary capillary (RPC) density in the early stages of diabetic retinopathy (DR), using optical coherence tomography angiography.

Methods:
A cross-sectional evaluation of RPCs was performed using optical coherence tomography angiography (Avanti RTVue-XR 100, Optovue Inc, Fremont, CA). Annular RPC density was the primary outcome. Global density and retinal nerve fiber layer thickness were secondary outcomes. Diabetic eyes were divided into three groups: no DR, mild nonproliferative DR (mild NPDR), and moderate NPDR. Multilevel mixed-effects univariate and multivariate linear regression models were used.

Results:
We included 155 eyes (n = 42 control; n = 27 no DR; n = 28 mild NPDR; and n = 58 moderate NPDR) from 86 subjects (mean [SD] age 63.39 [10.70] years; 46.45% male). When compared with controls, a significant decrease in annular RPC density was found in all groups of diabetic eyes on multivariate analysis (no DR: β = −2.95, P < 0.001; mild NPDR: β = −1.76, P = 0.017; and moderate NPDR: β = −2.82, P < 0.001). We also detected a significant decrease in retinal nerve fiber layer thickness in diabetic eyes (even in the no DR group). Furthermore, in diabetic eyes, annular RPC density and retinal nerve fiber layer thickness correlated significantly (R = 0.4874, P < 0.001).

Conclusion:
Peripapillary neurovascular changes occur early in the course of DR. Their significance in the progression of DR warrants further research.
The prevalence and years lived with disability caused by low back pain in China, 1990 to 2016: findings from the global burden of disease study 2016
Authors: Wu Aimin , Dong Wenlan , Liu Shiwei , Cheung Jason Pui Yin , Kwan Kenny Yat Hong , Zeng Xinying , Zhang Kai , Sun Zhenyu , Wang Xiangyang , Cheung Kenneth Man Chee , Zhou Maigeng , Zhao Jie 
Published: September 2018

Abstract
The aim of this work was to quantify the prevalence and years lived with disability (YLDs) caused by low back pain (LBP) in China from 1990 to 2016. Data from the GBD 2016 (Global Burden of Diseases, Injuries, and Risk Factors Study 2016) were used. We analyzed the age-sex-province-specific prevalence and YLDs for LBP of 33 provinces/regions in China. Comparisons were made with the data retrieved from the 1990 GBD study. We estimated that 5.45 × 107 individuals had LBP in 1990, which rose to 6.73 × 107 in 2016. The age-standardized prevalence of LBP decreased from 5.6% (95% uncertainty interval [95% UI]: 4.9%-6.3%) in 1990 to 4.2% (95% UI: 3.8%-4.8%) in 2016. The YLDs for LBP increased from 6.2 million (95% UI: 4.3-8.3 million) in 1990 to 7.7 million (95% UI: 5.4-10.2) in 2016. Age-standardized YLD rate (per 100,000 person) decreased from 637.5 (95% UI: 449.9-848.8) in 1990 to 481.9 (95% UI: 338.6-637.0) in 2016. A female preponderance was observed for prevalence and YLDs. The prevalence and YLDs rate for LBP slightly decreased from 1990 to 2016 in China; however, the total individuals and YLDs increased. Low back pain still ranks as the second leading cause of YLD burden disease in China. Considerable attention should be paid for LBP, especially in the female population.
Associations of catechol-O-methyltransferase (rs4680) single nucleotide polymorphisms with opioid use and dose among adults with chronic pain
Authors: Hooten W. Michael , Biernacka Joanna M. , O'Brien Travis G. , Cunningham Julie M. , Black John L. 
Published: September 2018

Abstract
Catechol-O-methyltransferase (COMT) regulates extracellular catecholamines. A widely studied COMT single nucleotide polymorphism (rs4680) changes the translated amino acid from valine to methionine (Val158Met); the polymorphism has been shown to influence opioid use. The aims of this study were to investigate the influence of COMT Val158Met on the likelihood and dose of opioid use in adults with chronic pain. Adults with chronic pain consecutively admitted to an outpatient pain rehabilitation program were recruited for study participation (N = 298). Individuals were genotyped for COMT Val158Met (rs4680). The polymorphism was analyzed using an additive and codominant genotype model. The distribution of genotypes was 23% (N = 70) for Val/Val, 49% (N = 146) for Val/Met, and 27% (N = 82) for Met/Met (Hardy–Weinberg, P > 0.90). No significant association was observed between opioid use and genotype under the additive model; however, a significant association was observed under the codominant model (P = 0.027). A post hoc comparison demonstrated that the Met/Met genotype was more likely to use opioids compared with the Val/Met genotype (P = 0.0089). No significant association was observed between morphine equivalent dose and genotype under the additive model; however, a significant association was observed under the codominant model (P = 0.0496). A post hoc comparison demonstrated that the Val/Met (P = 0.019) and Met/Met (P = 0.043) genotypes used greater morphine equivalent dose compared with the Val/Val genotype. This study extends key knowledge about the influence of the Met/Met genotype and Met allele on opioid use in adults with chronic pain.
PRISM: a brief screening tool to identify risk in parents of youth with chronic pain
Authors: Simons Laura E. , Lewandowski Holley Amy , Phelps Emily , Wilson Anna C. 
Published: September 2018

Abstract
Having a child with chronic pain impacts a parent's life. Reciprocally, parent cognitive, affective, and behavioral responses to the child's chronic pain can influence the child's pain experience. The purpose of this study is to develop a brief self-report screening tool (Parent Risk and Impact Screening Measure [PRISM]) of parent psychosocial functioning and behavioral responses to child pain. This measure assesses parents' reports of their own stress, health, psychosocial functioning, and disruption in activities due to their child's pain and related disability. In an effort to preliminarily validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. An initial 30-item PRISM was administered to 229 parents of children with persistent pain. Parents also reported on distress, protectiveness, pain catastrophizing and family impact, and youth completed measures of pain, pain-related disability, and quality of life. Item refinement resulted in a final 12-item PRISM tool. The PRISM demonstrates strong internal consistency, and initial support for construct validity was shown by associations with parent distress, protectiveness, and catastrophizing. Results also revealed higher PRISM scores are associated with higher child pain intensity, greater functional disability, and poorer quality of life. Cutoff scores were determined to identify parents at differing levels of risk. The PRISM is a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Further validation will use PRISM in longitudinal studies, particularly testing PRISM scores as a predictor of parent and child outcomes over time.