Quality of life assessment after total knee arthroplasty in patients with Parkinson's disease.

BACKGROUND: The number of Parkinson's patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA. METHODS: Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score (KSS). The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL. RESULTS: Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures:EQ-5D index (0.545-0.717, P < 0.01), PDQ (81.1-52.3, P < 0.01) and PHQ-9(8.22-5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0-81.4, P = 0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P < 0.01) and PDQ (81.4vs.52.3, P < 0.01) at the LFU. CONCLUSION: TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.

Functional Connectivity Changes of the Visual Cortex in the Cervical Spondylotic Myelopathy Patients: A Resting-State fMRI Study.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To analyze altered functional connectivity (FC) in the visual cortex of cervical spondylotic myelopathy (CSM) patients using resting-state functional magnetic resonance imaging (fMRI). SUMMARY OF BACKGROUND DATA: We previously showed changes in visual cortex neural activity in CSM patients. METHODS: Thirty CSM patients and 20 healthy controls were recruited. MR data were collected using a 3.0 T MR. FC of the regions of interest (ROI) (Brodmann areas [BA] 17/18/19/7) were calculated in a voxel-wise manner and compared between groups. Correlation analyses were performed between preoperative Japanese Orthopaedic Association (JOA) scores and altered FC, as well as between preoperative best corrected visual acuity (BCVA) and altered FC. Furthermore, the FC where was compared between the preoperative and the postoperative CSM patients in an ROI-wise manner. RESULTS: Increased FC was found between BA19 and the cerebellum inferior lobe; between the left BA7 and bilateral calcarine, right lingual, right fusiform gyrus, and left precuneus (BA17); between the left BA7 and right fusiform gyrus and right inferior occipital gyrus (right BA19); and between the right BA7 and right superior lobe of cerebellum (right BA19) in CSM patients (P < 0.05). A negative correlation was found between JOA score and FC of the left and right BA19, and a positive correlation was found between the BCVA and FC of the left and right BA7 (P < 0.05). ROI analysis demonstrated statistically significant FC differences in between the preoperative and the postoperative CSM patients (P < 0.05). CONCLUSION: FC changes were present in the visual cortex of CSM patients, which negatively correlated with preoperative JOA scores and positively correlated with preoperative BCVA. Significant recovery of FC in the visual cortex was detected in CSM patients postoperatively. LEVEL OF EVIDENCE: 4.

Disc associating axial pain were indicated by PLL resection in ACDF surgery.

PURPOSE: The generation and tissue origination of disc-associated axial pain is still under exploration. This study was performed to evaluate disc-associated axial pain and to explore whether it originates in the disc or its surrounding components. METHODS: A 6-year series of 88 single-level Smith-Robinson disc and posterior longitudinal ligament (PLL) resections performed to treat single-level cervical spondylotic myelopathy was retrospectively examined. All single-level anterior disc decompressions were performed under local infiltration anesthesia; the PLL was not anesthetized to avoid cervical cord block. The patients were grouped by disc level. The centered foci of the pain localization were subjectively recorded before, during, and after the operation. Radiological examinations (plain X-ray, computed tomography, and magnetic resonance imaging) were performed before and after the operation to diagnose the compression and evaluate the decompression. RESULTS: All 88 patients who underwent single-level PLL resection had no intraoperative pain responses except during resection of the PLL. Their provoked pain responses were similar to their familiar pain responses. The axial pain disappeared postoperatively. Complications developed in six patients (6.8 %). All patients recovered well, and the absence of the axial pain was maintained at the 12-month follow-up. CONCLUSIONS: Preoperative axial pain due to single-level disc protrusion was triggered and aggravated only during PLL resection and disappeared postoperatively. This implies that the intervertebral PLL could be the site of origination of axial pain. Axial pain from the PLL at different disc levels had different distributions.

Effect of BMPs and Wnt3a co-expression on the osteogenetic capacity of osteoblasts.

In the present study, third­generation autologous­inactivated bone morphogenic protein 2 (BMP2), BMP4, BMP6, BMP7, BMP9 and Wnt3a lentiviral vectors were constructed and integrated into the genome of MC3T3­E1 murine mesenchymal stem cells (MMSCs) to produce osteoinductive factor gene­modified MMSCs. The transfection efficiency of each osteoinductive factor was then determined by detecting the expression levels of runt related transcription factor 2 (Runx2) mRNA. The cotransfection with combinations of two lentiviruses was performed, and the expression levels of bone γ­carboxyglutamate protein and alkaline phosphatase in the MC3T3­E1 cell culture supernatant were detected. The expression level of Runx2 mRNA was detected by reverse transcription­polymerase chain reaction, and western blotting was performed to detect the protein expression levels of BMP2, BMP4, BMP6, BMP7, BMP9 and Wnt3a. The results demonstrated that the recombinant lentiviruses were successfully transfected into MC3T3­E1 cells. The relative expression levels of Runx2 mRNA were greatest in the BMP2 group, sequentially followed by the BMP4, BMP9, BMP7, Wnt3a and BMP6 groups. The results of cotransfection of MC3T3­E1 cells (a total of 8 groups) demonstrated that BMP­2 and BMP­7 exhibited the highest cotransfection efficiency. Western blot analysis demonstrated that following BMP2 and BMP7 cotransfection of MC3T3­E1 cells, the protein expression levels of BMP2, BMP4, BMP6, BMP7, BMP9 and Wnt3a were increased compared with control cells. In conclusion, the third­generation lentiviral vectors effectively improved the osteogenic efficiencies of MC3T3­E1 cells, which provided an important theoretical basis and therapeutic strategy for bone reconstruction and tissue engineering.

Circumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T10 -L1.

OBJECTIVE: To describe a novel surgical strategy for circumferentially decompressing the T10 -L1 spinal canal when impinged upon by single level hard thoracic herniated disc (HTHD) via a modified costotransversectomy approach. METHODS: This is a retrospective review of 26 patients (17 men, 9 women; mean age at surgery 48.5 years, range 20-77 years) who had undergone single level HTHD between T10 -L1 by circumferential decompression via a modified costotransversectomy approach. The characteristics of the approach are using a posterior midline covered incision, which keeps the paraspinal muscle intact and ensures direct visualization of circumferential spinal cord decompression of single level HTHD between T10 -L1 . RESULTS: The average operative time was 208 ± 36 min (range, 154-300 min), mean blood loss 789 ± 361 mL (range, 300-2000 mL), mean preoperative and postoperative mJOA scores 5.2 ± 1.5 and 9.0 ± 1.3, respectively (t = 19.7, P < 0.05). The rate of recovery of neurological function ranged from 33.3% to 100%. The ASIA grade improved in 24 patients (92.3%) and stabilized (no grade change) in two (7.7%). MRI indicated that the cross-sectional area of the dural sac at the level of maximum compression increased from 45.0 ± 5.8 mm(2) preoperatively to 113.5 ± 6.1 mm(2) postoperatively (t = 68.2, P < 0.05). Anterior tibialis muscle strength of the 15 patients with foot drop had a mean recovery rate of 95% at final follow-up. One patient who resumed work early after the surgery showed a significantly augmented Cobb angle. One patient had transient postoperative cerebrospinal fluid leakage. No patients showed neurological deterioration. CONCLUSIONS: This procedure achieves sufficient direct visualization for circumferential decompression of the spinal cord via a posterior midline covered costotransversectomy approach with friendly bleeding control and without muscle sacrifice. It is a reasonable alternative treatment option for thoracic myelopathy caused by single level HTHD between T10 -L1 .

Depression is associated with increased incidence of osteoporotic thoracolumbar fracture in postmenopausal women: a prospective study.

PROPOSE: To determine whether depression in postmenopausal women with osteoporosis is associated with an increased risk of thoracolumbar fragility fracture. METHODS: Postmenopausal women with osteoporosis and without prior vertebral fracture history who were seen at our institution from January 2006 to January 2010 (n = 1397) were divided into depression group (n = 494) and depression-free group (n = 903). After at least 4 years the incidence of thoracolumbar osteoporotic vertebral fracture was compared between the groups. For those who developed vertebral fracture, quality of life over the subsequent 2 months and fracture pain in the subsequent 2 weeks were compared. Depression was assessed with the 21-item Beck Depression Inventory, pain intensity with the visual analogue scale and quality of life with the Medical Outcomes Study 36-item Short-Form Survey. RESULTS: The incidence of thoracolumbar fractures among women with continuous depression was higher than the group without depression (35.43 vs. 25.14 %, respectively; (P < 0.05). Osteoporotic thoracolumbar fractures were associated with significantly lower quality of life scores in women with depression than in those without depression (P < 0.05). Fracture pain was experienced by a higher percentage of patients with continuous depression than by those without depression (44.00 vs. 27.31 %; P < 0.05). CONCLUSION: Depression is associated with a higher risk of thoracolumbar fracture, with more fracture pain and with lower quality of life in the 2 months following fracture.

Treatment of Atypical Central Cord Injury Without Fracture or Dislocation.

In general, spinal cord injury without radiological abnormality (SCIWORA) with spondylosis is considered to be a central cord injury. This article describes the clinical features and surgical outcomes of atypical central cord injury in patients with spondylotic SCIWORA (ACCISS). Fifty-two patients were enrolled in the study from January 2006 to December 2011. Diagnoses were made from imaging (computed tomography, magnetic resonance imaging) and clinical findings. The neurologic status of patients was assessed using the American Spinal Injury Association (ASIA) score and Japanese Orthopaedic Association (JOA) score. Patients were divided into 3 groups with regard to the timing of surgery after injury: those undergoing early surgery (less than 24 hours after injury), those undergoing late surgery (more than 24 hours after injury but during initial admission to the hospital and within 3 weeks from injury), and those undergoing delayed surgery (during second admission to the hospital, within 3 months but later than 3 weeks from injury). Seventeen patients underwent early surgery, 22 underwent late surgery, and 13 underwent delayed surgery. Mean follow-up was 15 months (range, 5-33 months). Patients in all groups showed very good recovery after surgical treatment, with the recovery rate of ASIA and JOA scores being 68.6% and 60.2%, respectively. No significant difference in recovery rate was found between the groups with regard to the timing of surgery. This retrospective study supports the notion that surgical decompression is effective in the treatment of patients with ACCISS. Timing of surgery (less than 3 months) was not significantly associated with neurologic recovery.

Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up.

PURPOSE: The aim of this research was to evaluate the long-term results of extensive laminectomy for the treatment of cervical spondylotic myelopathy due to multilevel cervical stenosis (MCS) with ligamentum flavum hypertrophy (LFH). METHODS: From January 2000 to December 2002, a total of 91 patients who underwent extensive laminectomy for MCS with LFH were included in this study to investigate the long-term outcome of this surgical option. All patients were presenting moderate-to-severe preoperative cervical myelopathy. The patients with cervical lordosis, without cervical kyphosis and instability, were included in our study through preoperative radiological examination. Clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) scoring system and by recovery rate (RR). The changes in curvature of cervical spine were determined by cervical curvature index (CCI). Range of motion (ROM) of the cervical spine was assessed by measuring the C2-7 Cobb angle on flexion and extension. The anteroposterior diameters and the drift-back distance of the spinal cord were calculated using the MRI image. The axial pain was measured by a visual analogue scale (VAS). Statistical analysis was performed using paired t test with significance set at P < 0.05. RESULTS: Ninety-one (83 %) of the 109 patients completed the follow-up in this study. The mean duration of follow-up was 12.1 years. The preoperative JOA scores in these patients averaged 6.8, and the postoperative scores at the final follow-up averaged 14.5 (average RR 68.4 %). The CCI decreased significantly from 20.8 ± 2.1 preoperatively to 11.5 ± 1.8 at last follow-up (t = 15.31, P < 0.01). The cervical ROM at C2-7 decreased from 42.7° before surgery to 20.4° at the final follow-up (t = 21.16, P < 0.01). The increased anteroposterior diameters at the level of maximum compression together with the significant drift-back distance of the spinal cord suggested that decompression was complete. The postoperative VAS score suggested that the axial pain was mild (1.4 ± 0.8). CONCLUSIONS: A series of clinical results were obtained after the extensive laminectomy for a long-term follow-up period exceeding 10 years. The extensive laminectomy may be an option for an alternative procedure for treatment of MCS with LFH.

Laminoplasty and laminectomy hybrid decompression for the treatment of cervical spondylotic myelopathy with hypertrophic ligamentum flavum: a retrospective study.

OBJECTIVE: To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF). BACKGROUND: Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. METHODS: This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. RESULTS: No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3 ± 15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. CONCLUSION: Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.

Effect of depression on femoral head avascular necrosis from femoral neck fracture in patients younger than 60 years.

The purpose of this study was to determine the effect of depression on femoral head avascular necrosis (AVN) from femoral neck fracture in patients younger than 60 years and the relationship between depression and postoperative quality of life. The Beck Depression Inventory-II (BDI-II) was completed by 641 patients (352 men and 289 women; average age, 41.7±10.2 years; range, 20-60 years) postoperatively. Patients were divided into groups according to BDI-II score: a depressed group (BDI-II score of 14 or higher) and a nondepressed group (BDI-II score lower than 14). They were followed for an average of 28 months (range, 24-37 months). The postoperative diagnosis was confirmed by typical radiographs and single photon-emission computed tomography. Quality of life among patients was assessed using the Short Form-36 (SF-36) questionnaire. The overall incidences of depression and AVN were 30.6% (196 of 641) and 20.9% (134 of 641), respectively. Ninety-four (48.0%) patients in the depressed group and 40 (9.0%) patients in the nondepressed group ultimately developed AVN. Symptoms of depression significantly affected AVN. In addition, depression predicted patients' quality of life, as did sex, partner status, employment status, living alone, frequency of exercise, severity of fractures, and length of hospital stay. In a multiple linear regression model analyzing all of these variables, depression was the best independent predictor of quality of life. Depression in patients younger than 60 years with femoral neck fractures may increase postoperative femoral head AVN risk and greatly affect patients' quality of life.

The CT and intraoperative observation of pedicel-ossification tunnel in 151 cases of thoracic spinal stenosis from ossification of ligamentum flavum.

PURPOSE: The aim of this study is to precisely illustrate the pedicle-ossification tunnel (POT)-a spinal cord-free pathway in upper facet joint en bloc resection, which was reported as a comparatively neurological safer decompression surgery for thoracic ossification of ligamentum flavum (OLF). METHODS: From 1998 to 2009, 151 patients with thoracic spinal stenosis from OLF were diagnosed by CT, MRI, neurological examinations and confirmed by postoperative pathological examination. The existence and configuration of the POT were observed by interactive CT virtual endoscopic (CTVE) image with multiplanar reconstructions and confirmed by intraoperative observation. Posterior decompression by upper facet joint en bloc resection via POT was conducted in all patients and the advantage of surgery was evaluated by modified Japanese Orthopedic Association scores pre- and post-operatively. RESULTS: Through CTVE and intraoperative observation, no spinal cord was found present in POTs. OLF bloc divided the foramen into three parts: upper POT, OLF bloc and lower POT. The POT was the epidural space between the lateral border of OLF and its neighboring pedicles inner cortex. The recovery rate of upper facet joint en bloc resection via POT was 75.24 ± 18.01 %. CONCLUSIONS: POT is a spinal cord-free pathway between OLF bloc and its neighboring pedicles in thoracic spinal stenosis which can be applied in neuron preserved decompression surgery.

Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study.

Posterior decompression surgery was performed on 610 patients (mean age 62 years) with clinically and radiologically defined cervical spondylotic myelopathy (CSM) at Tianjin Medical University General Hospital, between October 2007 and October 2011. After 2-year follow-up, we had a full data sets from 396 patients with normal mood or continued depression during the whole process to be compared. Depression was assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the modified Japanese Orthopedic Association (mJOA) scoring system, neck disability index (NDI), and visual analog scale (VAS). There were statistically significant differences from baseline to 2-year follow-up between normal mood (n = 258) and continuous depression (n = 138) groups in mJOA score (6.76 ± 3.12 vs. 1.42 ± 0.56, respectively; p < 0.01), VAS (23.85 ± 20.79 vs. 16.08 ± 19.76, respectively; p < 0.01), and NDI (21.11 ± 11.36 vs. 7.31 ± 2.18; p < 0.05). The adverse consequences of depression are supported by previous findings that patients with depression suffer more unsatisfactory surgery outcome than the patients with normal mood. We emphasize that patients with continuous depression show poorer improvement after posterior decompression in CSM patients with respect to symptom severity, pain intensity, and the disability score than patients without depression at any stage.

A report on the prevalence of depression and anxiety in patients with frozen shoulder and their relations to disease status.

Musculoskeletal diseases often have concomitant psychological disorders, such as depression and anxiety. Frozen shoulder (FS) is a musculoskeletal disease, and causes pain and stiffness in the shoulder. The relationship between FS and psychological disorders has rarely been investigated. This cross-sectional study was to evaluate the risk of depression and anxiety in patients with primary FS, and to explore the relationship between psychological disorders and disease status. In this study, anxiety and depression were evaluated in 124 patients (78 women and 46 men) with primary FS, compared with 130 (72 women and 58 men) age-, sex- and education matched healthy controls between March 2009 and June 2012. Simple shoulder test (SST); shoulder pain and disability index (SPADI); the range of motion (ROM); visual analog scales (VAS) for pain and sleep disturbances; hospital anxiety and depression scale for depression (HADS-D) and for anxiety (HADS-A); and health assessment questionnaire (HAQ) were used to assess clinical and psychological status. In FS patients, the prevalence of depression and anxiety was 28.2 and 24.2%, respectively. Compared with the healthy controls, higher HADS-D (6.41 ± 3.69, 5. 23 ± 2.87 p = 0.006) and HADS-A (6.16 ± 3.62, 4.90 ± 3.05 p = 0.003) were detected. The FS patients with depression or anxiety had significantly lower SST and HAQ scores, significantly higher VAS and SPADI scores and significantly higher prevalence of sleep disturbances compared with the FS patients with normal psychological status. The correlations of SST, SPADI, VAS and sleep disturbances but not ROM with HADS-A and HADS-D were significant ( p < 0.05). This finding indicates that anxiety and depression may coexist with FS; patients with psychological disorders have more severe self-reported shoulder pain and functional restriction.