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1.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1843109

ABSTRACT

ObjectivesThe COVID-19 pandemic has forced many people to stay at home and to maintain social distancing. This study aimed to assess the association of reduced physical activity during the COVID-19 pandemic with new onset of neck pain (katakori) among a rural Japanese population living in areas damaged by the Great East Japan Earthquake (GEJE).Design, setting and participantsThis prospective cohort study has been conducted continuously since 2011 after the GEJE. This study used longitudinal data from 1608 adults who responded to the self-reported questionnaire before and during the COVID-19 pandemic. Changes in physical activity due to the COVID-19 pandemic were categorised into four groups: ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’ and ‘almost never go out’. Multiple logistic regression analysis was used to estimate the OR and 95% CI of the association between COVID-19 pandemic-related physical inactivity and new-onset neck pain.ResultsIn total, ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’, and ‘almost never go out’ were reported by 9.2%, 27.7%, 31.2% and 21.9% of respondents, respectively. Among them, 9.8% reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who reported ‘decreased by half’ (adjusted OR 1.85, 95% CI 1.04 to 3.30) and who ‘almost never go out’ (adjusted OR 2.13, 95% CI 1.16 to 3.91), compared with those who reported ‘no change.’ConclusionsDecreased physical activity has increased due to the COVID-19 pandemic and was significantly associated with new-onset neck pain among GEJE survivors.

2.
Cureus ; 14(2): e22630, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1835727

ABSTRACT

Introduction The COVID-19 pandemic resulted in a transition to a virtual format for all medical residency and fellowship application processes. Previous studies have discussed the successful implementation of virtual interviews, but a deep analysis of how the application process has changed for orthopedic surgery fellowship programs during the pandemic is lacking. The purpose of this study was to assess how COVID-19 impacted the orthopedic spine fellowship application and selection process. Methods A web-based survey was administered to the program directors of all 75 U.S. orthopedic surgery spine fellowship programs, which often can accept both orthopedic surgery and neurosurgery trained graduates. Questions focused on the changes from the 2019-2020 application cycle to the 2020-2021 cycle. We collected data on connecting with potential applicants, the general application process, and interviews offered by programs. Univariate analyses were used to compare data from the 2020-2021 cycle with the prior 2019-2020 cycle. Results Twenty-five of the 75 contacted program directors responded to our survey (33% response rate). The percentage of programs that offered virtual open houses/meet-and-greets increased from 20% in 2019-2020 to 52% in 2020-2021 (p=0.018). Social media use was unchanged (0.0% vs. 4.0%, p>0.05). Compared to the prior year, the number of interviews offered by programs increased by 1.5 (32.7 vs. 21.9 interviews, p=0.024). There were no significant differences in the numbers of applications received by programs, interview dates available, or separate interviews each candidate completed during an interview day (p>0.05 for all). The in-person interview was the most important factor in 2019-2020 for selecting applicants, whereas the virtual interview, letters of recommendation (LOR), and research were equally ranked as the most important factors in 2020-2021. Regarding interviews, 50% of respondents would "likely" consider virtual interviews as an option in addition to in-person interviews in the future, but most (55%) answered that it was "unlikely" that virtual interviews would entirely replace in-person interviews. Conclusion Spine fellowship programs were more likely to use virtual social events to recruit potential applicants, send out more interview invitations, and equally consider LOR and research with interview performance during an entirely virtual application cycle. Half of the program directors would consider offering virtual interviews as an option for future application cycles, which may help reduce costs associated with the process.

3.
Acta Informatica Medica ; 30(1):11-17, 2022.
Article in English | EMBASE | ID: covidwho-1822558

ABSTRACT

Background: Scientometrics, a subfield of bibliometrics, examines scientific publications by using bibliometric methods. The aim of a scientometric study is to study the various citation-based metrics of scientific articles, such as parameters pertaining to authors (including institutions and country of origin), articles, journals, and other citation related metrics. Objective: In this second part of our scientometric analysis of the 6 major neurosurgical journals from 2011-2020, we study journal and author trends, yearly publication trends, and citation related metrics in Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, Operative Neurosurgery, and World Neurosurgery. Methods: We analyzed parameters, including article and journal metrics (total articles published per journal per year, breakdown of the Bradford's law distribution of journals, and Lotka's law, journal impact factors), author metrics (country of origin, collaborations), citation totals, and keyword counts. Results and Discussion: The highest number of published articles from all journals occurred in 2011, the lowest in 2016. World Neurosurgery published the most. The author collaboration index has declined since 2016 with a notable drop in 2020 when the COVID-19 pandemic began. Impact factors remained stable, except for Operative Neurosurgery, which experienced a steep decline in 2020, and World Neurosurgery, which experienced a mild decline in 2020. Canadian authors were the most likely to participate in multi-country collaborations. Conclusion: The most articles were published in Journal of Neurosurgery, followed by Neurosurgery, Spine, and World Neurosurgery.

4.
Clinical Osteology ; 26(4):186-190, 2021.
Article in Czech | EMBASE | ID: covidwho-1820623

ABSTRACT

COVID-19 is an emerging infectious disease that has specific characteristics that interfere with the care of patients with osteoporosis. This article discusses the interfaces between osteological issues and COVID-19. A prevalent fracture very modestly increases the risk of death from COVID-19 but in hospitalized patients, the prevalence of vertebral fracture can be considered another aspect of polymorbidity increasing the likelihood of an adverse course of infection. Vitamin D deficiency correlates with worse outcomes in COVID-19, and sufficient vitamin D saturation is very likely protective in relation to COVID-19. Containment measures at the peak of the pandemic may result in muscle loss and increased risk of falls in the elderly. Densitometry and majority of laboratory tests can be easily delayed in patients with osteoporosis. This also applies to parenteral administration of bisphosphonates, whereas continuation of oral bisphosphonate therapy can be ensured by electronic prescription. Teriparatide should not be discontinued for more than 2–3 months, and the interval between denosumab administrations should not exceed 7 months.

5.
Spine Surg Relat Res ; 6(2): 109-114, 2022.
Article in English | MEDLINE | ID: covidwho-1818985

ABSTRACT

Introduction: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, the importance of triaging surgeries was suggested to reduce burdens on the existing health system and maintaining service. The governor declared a state of emergency and requested that residents avoid going out unnecessarily (semi-lockdown) for the entire prefecture including our medical region from February 28 until May 25, 2020. However, for several spine patients, a significant delay in care may result in the progression of extremity weakness and pain. This study aimed to investigate trends of spine surgeries during the first COVID-19 semi-lockdown in the nonepidemic region in Japan. Methods: Spine surgeries performed in our institution from February 28 until May 25 between 2017 and 2020 were retrospectively reviewed and analyzed. We compared the number of spine surgeries and types of surgical spine pathologies between 2017 and 2019: previous years and 2020: a COVID-19 year. Results: The mean number of spine surgeries performed in previous years was 121 cases, and the number of spine surgeries performed in a COVID-19 year was 109 cases. The percentage of urgent surgeries was 19.6% in previous years versus 37.6% in a COVID-19 year; the difference was statistically significant (P<0.05). Among the urgent surgical spine pathologies, the prevalence of cauda equina or severe nerve root compression leading to progressive neurological deterioration or intractable pain was 20.2% in a COVID-19 year, which was significantly higher than 12.4% in previous years (P<0.05). Conclusions: The first COVID-19 semi-lockdown in Japan led to a decrease in elective cases and an increase in urgent cases and might affect progressive neurological deterioration for some spine patients even in a nonepidemic region.

6.
Clinical Neurosurgery ; 67(SUPPL 1):241, 2020.
Article in English | EMBASE | ID: covidwho-1816196

ABSTRACT

INTRODUCTION: The COVID19 pandemic ended all national and international in-person educational conferences. In response to this, and in an effort to continue sharing and advancing knowledge in spine surgery, a multi-institutional collaboration formed a “virtual” spine educational platform. METHODS: Our group, consisting of five spinal neurosurgeons and one neuroradiologist, formed an online platform called the Virtual Global Spine Conference (VGSC). A website was created and maintained by the Weill Cornell Neurosurgery Department, and biweekly, Zoom meetings were established where prominent spine physicians from various specialties would deliver case-based presentations on spine and spine surgery related conditions at no cost to the participants. The “faculty hosts” coordinated the speakers, promotion and delivery of the program. All sessions are recorded and archived online. RESULTS: In less than one month, over 1000 surgeons, trainees and other specialists signed up for the program, with a continuous rate of 50- 100 new registrants per week. Each session draws an audience of 200- 300 participants. An early survey to the participants indicated that 94% would like this program to continue post-COVID. CONCLUSION: The early success of the Virtual Global Spine Conference is a reflection of the continued interest in spine education despite the COVID pandemic. There is widespread opinion, backed by our own survey results, that many want to see “virtual” education continue post-pandemic. The future goals of VGSC are to continue to deliver high-quality sessions led by prominent surgeons and other specialists, to better engage and collaborate with national organizations, and to collect long-term, granular data to better assess effectiveness and quality of this program.

7.
Clinical Neurosurgery ; 67(SUPPL 1):235, 2020.
Article in English | EMBASE | ID: covidwho-1816195

ABSTRACT

INTRODUCTION: As ofMay 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. METHODS: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS: The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a highrisk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator: https://jhuspine3.shinyapps. io/SpineUrgencyCalculator/ CONCLUSION: Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

8.
Clinical Neurosurgery ; 67(SUPPL 1):62, 2020.
Article in English | EMBASE | ID: covidwho-1816188

ABSTRACT

INTRODUCTION: Neurosurgery is one of the youngest and rapidly evolving surgical disciplines. After adequate training, residents graduate with the capability to practice across different settings such as academic centers, community hospitals, and others. We present the effect of COVID 19 pandemic on the surgical case volume in a US training program. METHODS: We retrospectively reviewed operative case volume at our program for the year 2019 and January-mid April 2020.We chose to include the mid-March to mid-April period as it corresponded to the time when our institution started deferring elective cases. We categorized cases as an elective cranial, elective spine, and emergency (trauma and other non-elective cases). We then summarized and compared the number of cases during this period. RESULTS: The average number of cases in 2019 was 99 cases per month (37 elective cranial, 42 elective spine, and 20 emergent). In 2020, The total case number in January, February, March, and mid-March to mid-April was 97, 86, 71, and 41cases respectively. In comparison to January 2020, February, March, mid-March to mid-April showed a 12%, 27%, and 58% reduction in the number of cases. The absolute number of emergent cases was comparable in January through mid-April 2020 (17,11,15, and 16) but in mid-March to mid-April emergent cases constituted 39% of the total case number. CONCLUSION: Neurosurgical residency is an eighty-four months of rigorous training with a minimum of 800 cases is required to prepare residents for a successful career in neurosurgery. The significant decline in the number of cases due to COVID 19 might affect the quality of training, especially for senior residents.

9.
Clinical Neurosurgery ; 67(SUPPL 1):54, 2020.
Article in English | EMBASE | ID: covidwho-1816184

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has substantially disrupted inpatient and outpatient neurosurgical care. METHODS: Patients who underwent a neurosurgical operation, inpatient consult, or outpatient appointment at Vanderbilt University Medical Center between March 23, 2019 and April 20, 2020 were identified. The March 23, 2020 Tennessee gubernatorial executive order was used to distinguish pre-and post-COVID cases. RESULTS: The total number of pre-and post-COVID cases was 4,152 and 195, respectively. Overall, a 45% reduction in median weekly operative case volume was demonstrated (82/week to 45/week;P=.001) after March 23. There was an observed downtrend in case volume in the weeks leading up to March 23. There was a 47% reduction for adult procedures (68/week to 36/week;P = .001) and 29% reduction for pediatrics (14/week to 10/week;P = .017). Among adult procedures, the most significant decreases were seen for spine surgeries (P = .008) and endovascular procedures (P = .036). Total weekly inpatient consults to adult neurosurgery decreased by 30% (97/week to 68/week;P <.001) with no significant change to pediatric consults. Adult and pediatric outpatient clinic visits decreased by 28% (552/week to 400/week;P = .021), with a 54% decrease for in-person encounters (551/week to 254/week;P = .001). Weekly Telehealth encounters increased from 0/week to 130/week. CONCLUSION: There was a significant reduction in pediatric and adult neurosurgical procedures, clinic visits, and adult inpatient consults during COVID-19. Telemedicine was increasingly used for assessment. Identifying neurosurgical procedures most impacted by COVID-19 delays may aid in the development of effective triage strategies for elective surgeries as they are reinstated.

10.
J Clin Neurosci ; 101: 131-136, 2022 May 02.
Article in English | MEDLINE | ID: covidwho-1814789

ABSTRACT

The stringent restrictions from shelter-in-place (SIP) policies placed on hospital operations during the COVID-19 pandemic led to a sharp decrease in planned surgical procedures. This study quantifies the surgical rebound experienced across a neurosurgical service post SIP restrictions in order to guide future hospital programs with resource management. We conducted a retrospective review of all neurosurgical procedures at a public Level 1 trauma center between February 15th to August 30th for the years spanning 2018-2020. We categorized patient procedures into four comparative one-month periods: pre-SIP; SIP; post-SIP; and late recovery. Patient procedures were designated as either cranial; spinal; and other; as well as Elective or Add-on (Urgent/Emergent). Categorical variables were analyzed using χ2 tests and Fisher's exact tests. A total of 347 cases were reviewed across the four comparative periods and three years studied; with 174 and 152 spinal and cranial procedures; respectively. There was a proportional increase; relative to historical controls; in total spinal procedures (p-value < 0.001) and elective spinal procedures (p-value < 0.001) in the 2020 SIP to Post-SIP. The doubling of elective spinal cases in the Post-SIP period returned to historical baseline levels in three months after SIP restrictions were lifted. Total cranial procedures were proportionally increased during the SIP period relative to historical controls (p-value = 0.005). We provide a census on the post-pandemic neurosurgical operative demands at a major public Level 1 trauma hospital, which can potentially be applied for resource allocations in other disaster scenarios.

11.
Pain Physician ; 24(5):319-325, 2021.
Article in English | ProQuest Central | ID: covidwho-1812623

ABSTRACT

BACKGROUND: The COVID-19 infection poses a serious threat to global health for millions of people. In addition to therapeutic treatment methods, preventive measures are also important in controlling the pandemic. As a result, billions of people are quarantined in their homes to prevent the spread of coronavirus. However, social isolation may result in immobility, which can lead to musculoskeletal problems and an increased level of pain, depending on the weakness of the muscles. OBJECTIVES: To examine the effect of social isolation during the recent COVID-19 pandemic on patients with chronic low back pain. STUDY DESIGN: A total of 145 patients who underwent a spine intervention within the past year were enrolled in this prospective and cross-sectional study. SETTING: The study was performed in the interventional pain unit of a tertiary rehabilitation center in Turkey. METHODS: Patient data were obtained by telephone interview and included information pertaining to demographics, pain history, an assessment of pain, analgesic use, activity levels, and an evaluation of stress and sleep habits. Additionally, the International Physical Activity Questionnaire (IPAQ) was used to evaluate patient activity levels. RESULTS: It was detected that social isolation has increased the intensity of low back pain experienced by patients during the COVID-19 pandemic. We also found that patients who benefited from spinal injections administered in the prepandemic period experience less severe low back pain (P = 0.000) and took fewer analgesics (P = 0.000) during the pandemic. The findings of our study revealed that there was a significant reverse correlation between IPAQ walking scores and the prepandemic Visual Analog Scale (VAS) scores (P = 0.015, r = -0.201) and the pandemic VAS scores (P = 0.000, r = -0.313).By contrast, the level of benefit from injections decreased (P < 0.05) and the duration of spinal intervention was shortened in patients with high IPAQ sitting scores (P < 0.05). LIMITATIONS: The limitations of the study are the small number of patients and the fact that our results are based on patients’ self-reported data. CONCLUSIONS: Social isolation has had an increasing effect on low back pain during the COVID-19 pandemic. The results of our study showed a significant relationship between activity level and pain intensity. We also found that patients who have benefited from spinal injections administered in the prepandemic period experience less severe low back pain during the pandemic.

12.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 2):88, 2022.
Article in English | EMBASE | ID: covidwho-1798740

ABSTRACT

Introduction: Scoliosis refers to the lateral curvature of the spine, which is progressive leading to morphological changes affecting quality of life, postural disability, even causing respiratory distress. Hence, screening the prevalence of scoliosis is much needed at a very early stage among school going children, thereby preventing permanent damage and spinal disorders that worsens. Aim: This study was undertaken to identify the prevalence of scoliosis among school going children in Puducherry thereby adequate adequate knowledge shall be provided to them to make them aware of the clinical condition,change their perception about the disease and motivate them to take necessary steps to overcome scoliosis at an earlier phase. Materials and Methods: A total of 1164 children (724 boys, 440 girls) aged from 6-17 years, were recruited for the study (since COVID-19 phase, most of the educational institutions were conducting only online sessions). The screening procedure included Adam's test(forward bending test) and scoliometer measurements, if >70 referred for poster anterior radiograph of the trunk, where Cobb angle is measured ,and if found to be >200 were identified to have scoliosis. The objectives were fully informed to the parents and the students and respondents were allowed to participate voluntarily. The data obtained were analyzed statistically. Results: A total of 60 students were found positive on forward bending test and scoliometer measurements >7°, among which 22 were confirmed with scoliosis on standing radiographs., 16 (73%) girls and 6 (27%) boys. Thirty-eight of which 23 (60%) girls and 15 (40%) boys had normal spine curvatures on X- ray examination (false positive). Conclusion: A total of 60 students were suffering from scoliosis, who needs further attention and the same have been informed to the concerned parents.

13.
Surg Neurol Int ; 13: 125, 2022.
Article in English | MEDLINE | ID: covidwho-1791396

ABSTRACT

Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system that may present with a wide variety of clinical presentations. However, there can be substantial overlap between symptoms from MS and those caused by lumbar spondylosis and/or postviral plexopathies. Case Description: A 33-year-old female with a history of an L5-S1 anterior lumbar interbody fusion and exposure to the SARS-CoV-2 virus developed postoperative worsening of her symptoms interpreted as "radiculopathy." Despite a subsequent L5-S1 fusion, she continued to neurologically deteriorate and was ultimately diagnosed with MS. Conclusion: The initial symptoms/signs of MS may mimic lumbar radiculopathy and or postviral plexopathy (i.e., due to recent COVID-19). This report should serve as a warning to future spinal surgeons to better differentiate between radicular and other "complaints," sufficient to avoid unnecessary repeated spinal surgery.

14.
Applied Sciences ; 12(7):3657, 2022.
Article in English | ProQuest Central | ID: covidwho-1785493

ABSTRACT

Mixed reality presents itself as a potential technological tool for the management of people with musculoskeletal disorders, without having as many adverse side effects as immersive virtual reality. The objective of this study was to explore the possibilities of a mixed-reality game, performing task-oriented cervical exercises compared to conventional therapeutic exercises in sensorimotor outcome measures in asymptomatic subjects. A randomized crossover pilot study was performed with two intervention groups: a mixed-reality group (MRG) and a conventional exercise group (CEG). The cervical joint position error test (CJPET) and deep cervical flexor endurance test (DCFET) were measured as sensorimotor outcomes. Statistically significant differences were found in the pre–post comparison in the DCFET for both groups (MRG: t = −3.87, p < 0.01;CEG: t = −4.01, p < 0.01) and in the extension of the CJPET for the MRG (t = 3.50, p < 0.01). The rest of the measurements showed no significant differences comparing both groups pre- and postintervention (p > 0.05). Mixed reality has apparently the same positive effects as conventional exercises in sensorimotor outcomes in asymptomatic subjects. These results could help in future studies with mixed virtual reality in the management of people with musculoskeletal disorders.

15.
Eur Spine J ; 2022 Apr 07.
Article in English | MEDLINE | ID: covidwho-1782812

ABSTRACT

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

16.
J Chiropr Educ ; 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1786267

ABSTRACT

OBJECTIVE: Faced with COVID-19 safety protocols that severely limited the ability to conduct chiropractic technique instruction in the usual manner, our university invested the resources to develop a new mannequin lab for hands-on training, which would help supplement the loss of person-to-person contact. METHODS: Training mannequins could enable student learning of palpation and adjustment skills while avoiding close human-human contact. The university had developed a mannequin over the previous 4 years consisting of a full-sized human torso with individually movable and palpable vertebrae, pelvis, and thighs. In the mannequin, 64 pressure sensors are attached to particular vertebral and skeletal landmarks and provide feedback on palpation location and level of force applied. We assembled 3 teams to produce 20 copies of that mannequin for student use. RESULTS: Mannequins were produced in 7 weeks, and space was built out for a special lab. Faculty members are developing classroom procedures to introduce the mannequin to students, phase in the skills from static and motion palpation, and practice thrust performance. CONCLUSION: The production run was successful, and the resulting equipment, well-received by students and faculty. In addition to helping teach manual skills, the lab serves as a platform for educational research to test the efficacy of mannequin-based training protocols. With the pressure sensors on known locations along the spine, future research may be able to test the ability of students to identify and contact specific target locations for adjustive thrusts.

17.
Medicina (Kaunas) ; 58(4)2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1776284

ABSTRACT

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient care in spine surgery, the educational needs of medical students, residents, and patient rehabilitation can be enhanced by digital transformation (DX), including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR), three-dimensional (3D) medical images and holograms; wearable sensors, high-performance video cameras, fifth-generation wireless system (5G) and wireless fidelity (Wi-Fi), artificial intelligence, and head-mounted displays (HMDs). Furthermore, to comply with the guidelines for social distancing due to the unexpected COVID-19 pandemic, the use of DX to maintain healthcare and education is becoming more innovative than ever before. In medical education, with the evolution of science and technology, it has become mandatory to provide a highly interactive educational environment and experience using DX technology for residents and medical students, known as digital natives. This study describes an approach to pre- and intraoperative medical education and postoperative rehabilitation using DX in the field of spine surgery that was implemented during the COVID-19 pandemic and will be utilized thereafter.


Subject(s)
Augmented Reality , COVID-19 , Education, Medical , Artificial Intelligence , Education, Medical/methods , Humans , Pandemics
18.
Front Surg ; 9: 853441, 2022.
Article in English | MEDLINE | ID: covidwho-1776104

ABSTRACT

Aim: Limited data are available on the impact of the coronavirus disease 2019 (COVID-19) pandemic on patient-reported outcome measures (PROMs) in patients who underwent spine surgery. In this study, we aimed to investigate the associations between the COVID-19 outbreak in Taiwan (May 2021) and PROMs in patients who underwent spine surgery. Method: We retrospectively identified patients who underwent spine surgery during identical defined 6-week time-intervals (May 16 to June 30) in 2019, 2020, and 2021. PROMs, including visual analog scale (VAS) score for pain, Oswestry disability index (ODI), and EuroQol-5D (EQ-5D), were investigated before surgical intervention and at a 1-month follow-up. Relevant clinical information was collected from the electronic medical records of patients. Linear regression analysis was used to examine the association between the pandemic in 2021 (vs. 2019/2020) and the PROMs after adjusting for age, sex, and relevant clinical variables. Results: The number of patients who underwent spine surgery at our hospital during the identical defined 6-week time-intervals in 2019, 2020, and 2021 was 77, 70, and 48, respectively. The surgical intervention significantly improved VAS, ODI, and EQ-5D of the patients (1 month after surgery vs. before surgery, all p < 0.001) in all three study periods. However, there was a significant between-group difference in change from baseline in VAS (p = 0.002) and EQ-5D (p = 0.010). The decrease in VAS and increase in EQ-5D after surgery in 2021 were not as much as those in 2019 and 2020. The associations between the pandemic in 2021 (vs. 2019/2020) and changes in VAS (ß coefficient 1.239; 95% confidence interval [CI] 0.355 to 2.124; p = 0.006) and EQ-5D (ß coefficient, -0.095; 95% CI, -0.155 to -0.035; p = 0.002) after spine surgery were independent of relevant clinical factors. Conclusion: There was less improvement in short-term PROMs (VAS and EQ-5D) after spine surgery during the COVID-19 pandemic. Assessment of PROMs in surgical patients during a pandemic may be clinically relevant, and psychological support in this condition might help improve patients' outcomes.

19.
Front Public Health ; 9: 700148, 2021.
Article in English | MEDLINE | ID: covidwho-1775816

ABSTRACT

Background: An increasing number of Chinese elderly women stay at home and act as grandchildren sitters. In consequence of the frequent load-bearing, chronic lumbar fatigue probably caused a higher risk of lumbar degeneration, fatigue, and injury which has become one of the most important aging and health problems in China. In this study, a multi-mode lumbar finite element model (FEM) with specific bone mineral density (BMD) were developed and validated for further spine injury prevention and control. Methods: The material properties of lumbar vertebra were modified according to degenerated bone mineral density, and geometry was adjusted based on intervertebral disc height. The motion of lifting children was simulated by a 76 year-old Chinese women's FEM, and the stress distribution was calculated and predicted. Results: The pressure of L5-S intervertebral disc in the bending 3-year-old dummy lifting posture was significantly higher than the same posture without lifting, the maximum effective stress of endplate cartilage in the upright child lifting posture was 1.6 times that of the bending without lifting posture. And the fatigue risk limitation frequency of the upright with dummy posture was predicted with the functional equation of fatigue and stress which was deduced by genetic algorithm, which combined with the effective stress of lumbar vertebrae spongy bone calculated from FEM. Conclusions: The child-lifting motion could increase the risk of lumbar degeneration, fatigue, and injury in elderly women, and they should keep below the frequency limit of the motion of lifting children in their daily life. This study could put forward scientific injury prevention guidance to Chinese elderly women who lift children in daily life frequently.


Subject(s)
Fatigue , Lumbar Vertebrae , Aged , Bone Density , Child, Preschool , Fatigue/etiology , Female , Humans , Risk Assessment
20.
British Journal of Surgery ; 109(SUPPL 1):i6-i7, 2022.
Article in English | EMBASE | ID: covidwho-1769188

ABSTRACT

Aim: Approximately 2.6 million people see their GP for lower back pain (LBP) each year. Referrals for spinal surgery are increasing with varying effectiveness. Screening for neurosurgical red flags is critical to quickly identify the rare but serious causes of LBP, such as CES. The primary aim was to explore what effect COVID-19 had on the management pathway of these patients in primary care to investigate causes of LBP including ruling out CES. Method: A service evaluation of all patients presenting to a large primary care provider in West Yorkshire with lower back pain who underwent MRI lumbar/sacral spine investigation between March 2020 and March 2021 was conducted. Results: A total of 105 patients with matched MRI scans were included. Neurosurgical red flag screening was performed by virtual appointment only in 32 (30.5%) of patients. In 10 cases (9.5%), red flag screening was not documented. Radiological outcomes revealed three (2.9%) cases of CES. Thirty (28.6%) required onward referral to neurosurgery. The majority (n=56;53%) had demonstrated radiological pathology amenable to conservative management. Conclusions: During the pandemic, almost a third of patients in primary care did not receive a face-to-face examination to rule out red flags in lieu of virtual appointments and history alone. The majority of imaging revealed pathology that was amenable to conservative management. The safety of virtual consultations including telephone appointments to screen for neurosurgical pathology needs further investigation. If deemed safe, virtual patient pathways may be optimised to achieve effective recognition patients at risk of CES requiring neurosurgical intervention.

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