The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

Methods@#Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. @*Results@#This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. @*Conclusions@#The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.

Solitary vertebral amyloidoma of T5 causing spinal cord compression with recurrence after surgery. A case report and review of the literature

We report the case of a fifty-two years old patient who presented symptoms of spinal cord compression with incomplete paraplegia in relation to a solitary vertebral tumor of T5. The patient required an urgent surgery for decompression and fixation; the resection of the tumor was intralesional and was complemented by radiotherapy later on. Results of the histological examination confirmed the tumoral nature of the lesion and were compatible with the diagnosis of solitary amyloidoma of T5. The patient recovered progressively. The disease recurred few months later with extension to the lower level T6. The patient underwent a second surgery as complete as possible because the global prognosis of this kind of tumor is essentially related to local recurrence. So a double level vertebrectomy by posterior approach only was performed. At 2 years follow-up after the second surgery, the patient did not show any local recurrence and his neurological status was stable. The aim of this paper is to describe a rare case of thoracic solitary amyloidoma. Diagnosis of such a tumor is not easy due to its aspecific clinical and radiological presentation where more frequent lesions should be ruled out first

Complete cauda equina syndrome after caudal epidural steroid injection: a case report

Epidural caudal steroid injections are commonly used to relieve radicular pains. If minor complications have widely been reported, few major complications have been described. This case presentation reports a cauda equina syndrome following caudal epidural injection. The magnetic resonance imaging [MRI] performed revealed a hematoma inside a caudal meningocele. A surgical drainage of the hematoma was performed, in emergency, leading to symptoms relief. Caudal meningocele diagnosed by MRI before caudal steroid injection could represent a contraindication for this type of procedure

global tilt : Evaluation of a parameter considering the global spinopelvic alignment

Purpose: Regarding the close interaction between the spinal balance and the pelvis orientation no parameter is routinely used to describe and to evaluate the global spinopelvic balance, taking into account simultaneously the spinal part and the pelvic part of the global alignment. The global tilt was described to analyze malalignment, considering spinal and pelvic imbalance together. From a geometrical point of view, the global tilt is the sum of the C7 vertical tilt and the pelvic tilt. The aim of this study is to evaluate the global tilt by analyzing its correlation with spinal malalignment

Methods: A cohort of patients who underwent a lumbar pedicle subtraction osteotomy [PSO] for major sagittal malalignment was realized. All patients had preoperative and postoperative full spine EOS radiographies to measure spinopelvic parameters. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between different spinopelvic parameters, including the global tilt, was performed for preoperative and postoperative values

Results: Thirty-one consecutive patients were included. All parameters were correlated with spinal malalignment but the global tilt was the most correlated parameter in preoperative [r = 0.71] and in postoperative [r = 0.78]. When spinal and pelvic parameters were analyzed separately, 19% of patients presented mismatches between spine and pelvis

Conclusion: This study highlights the interest of a global parameter evaluating the spinal balance and the pelvic balance together. The global tilt appeared to be the most correlated parameter in this study with spinal malalignment and could be used for the interpretation of clinical series in spine surgery

Two adjacent levels dislocation of the cervical spine managed via an anterior only approach: a case report

We report the rare case of a 52-year-old man who presented an incomplete tetraplegia after a hang gliding accident. Computed tomography revealed a complete bilateral facet fracture-dislocation at the C4C5 level, with a unilateral facet fracture-dislocation on the left side at the C3C4 level; there was also a sagittal fracture of the fifth cervical vertebra extending through the middle of its body with a second fracture through the posterior arch. The patient was taken urgently to the operating room and closed reduction maneuvers were performed under general anesthesia, followed by an anterior prevascular approach for C3 to C5 fusion with two iliac crest grafts and a plate. Patient's muscle strength was 3/5 on all four limbs on discharge and between 4/5 and 5/5 at one year. He stopped self-catheterization nine months after the accident. At two years follow-up, X-rays and CT scan showed a stable construct with satisfactory fusion. This is the first paper, in the literature, to describe double level contiguous cervical dislocation with a sagittal split fracture, and managed via an anterior only approach