Association of early vertebroplasty with risk of hip replacement: A nationwide population-based cohort study in Taiwan.

Studies show that vertebral fractures could predict the risk of hip fractures. We aimed to evaluate the potential benefits of whether the timing of vertebroplasty (VP) for vertebral fracture associated with the risk of hip fracture for hip replacement.We identified 142,782 patients from the Taiwan National Health Insurance Database with thoracolumbar vertebral fracture (International Classification of Diseases, Ninth Revision, Clinical Modification:805.2-805.9) who were followed up from 2000 to 2013. These patients were divided into those who underwent VP (VP group) (International Classification of Diseases, Ninth Revision, Clinical Modification : 78.49) within 3 months and those who did not (non-VP group). After adjusting for the confounding factors, the Cox proportional hazards analysis was used to estimate the effect of early VP on reducing the risk of hip fracture. The difference in the risk of hip replacement, between the VP group and non-VP group was estimated using the Kaplan-Meier method with the log-rank test.In the 14-year follow-up, the cumulative incidence rate of hip replacement in the VP group was lower than that in the non-VP group (0.362% and 0.533%, respectively, long-rank P < .001). There was a significant difference between the 2 groups since the first-year follow-up.Our study showed that early VP performed to avoid progression of the kyphotic changes following thoracolumbar vertebral fracture may reduce the risk of hip fracture. These results, obtained from retrospective data, indicate that a prospective study is warranted.

Application of Surgical Apgar Score in intracranial meningioma surgery.

Surgical resection is the main therapeutic option for intracranial meningiomas, but it is not without significant morbidities. The Surgical Apgar Score (SAS), assessed by intraoperative blood pressure, heart rate, and blood loss, was developed for prognostic prediction in general and vascular surgery. We aimed to examine whether the application of SAS in patients undergoing craniotomy for meningioma resection can predict postoperative major complications. We retrospectively enrolled 99 patients that had undergone intracranial meningioma surgery. The patients were subdivided into 2 groups based on whether major complications were present (N = 34) or not (N = 65). We recognized the intergroup differences in SAS and clinical variables. The incidence of 30-day major complications in patients after operation was 34.3%. The lengths of ICU and hospital stay for the morbid cases were prolonged significantly (p = 0.009, p < 0.001, respectively). In the multivariate logistic regression model, SAS was an independent predicting factor of major complications following surgery for intracranial meningiomas (odds ratio, 95% confidence interval = 0.57, 0.38-0.87; p = 0.009), and thus a decrease of one mean SAS increased the rate of major complications by 43%. In conclusions, SAS is an independent predictor of major complications in patients undergoing intracranial meningioma surgery, and provides acceptable risk discrimination. Since this scoring system is relatively simple, objective, and practical, we suggest that SAS be included as an indicator in the guidance for the level of care after craniotomy for meningioma resection.

Surgical apgar score in patients undergoing lumbar fusion for degenerative spine diseases.

OBJECTIVE: Lumbar fusion is a procedure broadly performed for degenerative diseases of spines, but it is not without significant morbidities. Surgical Apgar Score (SAS), based on intraoperative blood loss, blood pressure, and heart rate, was developed for prognostic prediction in general and vascular operations. We aimed to examine whether the application of SAS in patients undergoing fusion procedures for degeneration of lumbar spines predicts in-hospital major complications. METHODS: One hundred and ninety-nine patients that underwent lumbar fusion operation for spine degeneration were enrolled in this retrospective study. Based on whether major complications were present (N=16) or not (N=183), the patients were subdivided. We identified the intergroup differences in SAS and clinical parameters. RESULTS: The incidence of in-hospital major complications was 8%. The duration of hospital stay for the morbid patents was significantly prolonged (p=0.04). In the analysis of multivariable logistic regression, SAS was an independent predicting factor of the complications after lumbar fusion for degenerative spine diseases [p=0.001; odds ratio (95% confidence interval)=0.35 (0.19-0.64)]. Lower scores were accompanied with higher rates of major complications, and the area was 0.872 under the receiver operating characteristic curve. CONCLUSION: SAS is an independent predicting factor of major complications in patients after fusion surgery for degenerative diseases of lumbar spines, and provides good risk discrimination. Since the scoring system is relatively simple, objective, and practical, we suggest that SAS be included as an indicator in the guidance for level of care after lumbar fusion surgery.

Prognostic Impact of Intracranial Pressure Monitoring After Primary Decompressive Craniectomy for Traumatic Brain Injury.

OBJECTIVE: Decompressive craniectomy (DC) for traumatic brain injury (TBI) can be used in 2 completely different situations: primary and secondary DC. Although intracranial pressure (ICP) monitoring has proved to be helpful in guiding therapy for head injuries, its role after primary DC is not well analyzed. The aim of this study was to elucidate the relationship between ICP monitoring and outcomes in patients undergoing primary DC for TBI. METHODS: We enrolled 187 head-injured patients undergoing primary DC in this retrospective study. The patients were subdivided into 2 groups based on whether postoperative ICP was monitored (n = 34) or not (n = 153). We identified the intergroup differences in clinical parameters and prognosis. Unfavorable and favorable neurologic outcomes were defined by Glasgow Outcome Scale scores of 1-3 and 4-5, respectively. RESULTS: The rate of ICP monitoring was 18.2% for our head-injured patients after primary DC. There was no difference in preoperative Glasgow Coma Score, pupil reactivity, features of computed tomography images, or other demographic variables between patients with or without ICP monitoring. The mortality at discharge was 14.7% for patients with ICP monitoring and 32.7% for patients without, which showed a statistically significant difference (P = 0.037). The neurologic outcomes did not differ between the patient groups at discharge or the end of follow-up. CONCLUSIONS: Our data suggest that ICP monitoring after primary DC for head-injured patients significantly decreases in-hospital mortality and should be implemented in neurocritical care to ensure the highest chances of surviving TBI.

Significant Blood Loss in Lumbar Fusion Surgery for Degenerative Spine.

OBJECTIVE: Lumbar fusion is a widely used procedure for degenerative spine diseases but frequently is accompanied with substantial surgical blood loss. We aimed to investigate the risk factors for significant intraoperative blood loss and the influence of excessive bleeding on postoperative complications in patients undergoing fusion for degenerative lumbar spines. METHODS: For this retrospective study, we enrolled 199 patients who had undergone lumbar fusion surgery for degeneration. The definition of significant blood loss at operation was 500 mL or more in blood volume. The patients were subdivided into 2 groups on the basis of whether significant blood loss was present (n = 107) or not (n = 92). RESULTS: The incidence of significant blood loss during lumbar fusion was 53.8%. In the multivariate logistic regression model, the independent risk factors for significant blood loss included body mass index (P = 0.027), extreme spinal canal narrowing (P = 0.023), spine fusion segments >1 level (P = 0.008), and transforaminal lumbar interbody fusion (P = 0.006). Significant blood loss in lumbar fusion was associated with a greater incidence of postoperative complications (P = 0.002). The length of hospital stay for patents with excessive bleeding was prolonged significantly (P = 0.045). CONCLUSIONS: Because substantial bleeding in lumbar fusion is associated with a greater incidence of morbidities and prolonged length of hospital stay, attention to the risk factors for significant blood loss is important in the preoperative assessment and postoperative guidance for the level of care.

Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease.

BACKGROUND: Adjacent segment disease is an important complication after fusion of degenerative lumbar spines. However, the role of body mass index (BMI) in adjacent segment disease has been addressed less. OBJECTIVE: To examine the relationship between BMI and adjacent segment disease after lumbar fusion for degenerative spine diseases. METHODS: For this retrospective study, we enrolled 190 patients undergoing lumbar fusion surgery for degeneration. BMI at admission was documented. Adjacent segment disease was defined by integration of the clinical presentations and radiographic criteria based on the morphology of the dural sac on magnetic resonance images. RESULTS: Adjacent segment disease was identified in 13 of the 190 patients, accounting for 6.8%. The interval between surgery and diagnosis as adjacent segment disease ranged from 21 to 66 months. Five of the 13 patients required subsequent surgical intervention for clinically relevant adjacent segment disease. In the logistic regression model, BMI was a risk factor for adjacent segment disease after lumbar fusion for degenerative spine diseases (odds ratio, 1.68; 95% confidence interval, 1.27-2.21; P < .001). Any increase of 1 mean value in BMI would increase the adjacent segment disease rate by 67.6%. The patients were subdivided into 2 groups based on BMI, and up to 11.9% of patients with BMI ≥ 25 kg/m were diagnosed as having adjacent segment disease at the last follow-up. CONCLUSION: BMI is a risk factor for adjacent segment disease in patients undergoing lumbar fusion for degenerative spine diseases. Because BMI is clinically objective and modifiable, controlling body weight before or after surgery may provide opportunities to reduce the rate of adjacent segment disease and to improve the outcome of fusion surgery.

Characterization of acute post-craniectomy seizures in traumatically brain-injured patients.

PURPOSE: Decompressive craniectomy (DC) is a life-saving measure for traumatic brain injury (TBI), but acute seizures following this procedure may have a devastating effect. We aim to investigate the clinical characteristics of acute post-craniectomy seizures. METHODS: For this retrospective study, we enrolled 195 patients undergoing DC for TBI. Acute post-craniectomy seizure was defined as seizures occurring within 7 days of DC. RESULTS: The incidence of acute seizure was 10.8% (21/195). 19 of 21 seizures occurred within 3 days following DC. None progressed to status epilepticus, but 16 of 21 patients (76.2%) with acute seizure developed epilepsy. There was no independent risk factor in the multivariate regression model. The mean hospital stay was 44.8 ± 34.6 and 28.8 ± 32.3 days for patients with and without acute seizures, respectively (p=0.035). The neurological outcome at discharge showed no inter-group difference (p=0.917). The in-hospital mortality rate was 28.6% for patients with seizures and 31.0% for patients without seizures (p=0.817). CONCLUSION: Acute seizures occur mostly within the first 3 days following DC. Neurological outcome and mortality rate at discharge does not differ between patients with or without seizures, but the duration of hospital stay is significantly longer for acute seizure patients.

Magnetic resonance imaging predictors for respiratory failure after cervical spinal cord injury.

BACKGROUND: Patients after cervical spinal cord injury (CSCI) may experience ventilator-dependent respiratory failure during the acute hospitalization period. The aim of the study is to identify imaging factors that predict respiratory failure after acute CSCI. MATERIALS AND METHODS: We enrolled 108 patients diagnosed with CSCI in 4 years. The definition of respiratory failure consisted of the requirement of a definitive airway and the assistance of mechanical ventilation. Objective neurological function was determined using the classification of the American Spinal Injury Association (ASIA). We evaluated the characteristics of magnetic resonance imaging (MRI) of the cervical spine. RESULTS: Respiratory failure occurred in 8 (7.40%) of 108 CSCI patients. The ASIA classification of the 108 patients were A (6), B (3), C (60), D (27), and E (12), and the 8 respiratory failure patients were A (3), B (1), and C (4). Seven of 8 patients with respiratory failure and 78 of 100 patients without respiratory failure had a neurological level of C5 or above by the ASIA standards (p=1.000). The imaging level of injury at C3 by MRI was identified in 5 of 8 patients that developed respiratory failure and more frequent than injury at the lower cervical levels (p<0.001). The presence of spinal cord edema was another predictor of respiratory failure (p=0.009). CONCLUSION: MRI can accurately localize CSCI and identify those patients at risk of respiratory failure. Imaging level of injury at C3 and presence of spinal cord edema are both predictors. To prevent secondary cord injury from prolonged hypoxia and facilitate pulmonary care, definitive airways should be established early in high risk patients.