Development of a predictive model for 1-year postoperative recovery in patients with lumbar disk herniation based on deep learning and machine learning.

Background: The aim of this study is to develop a predictive model utilizing deep learning and machine learning techniques that will inform clinical decision-making by predicting the 1-year postoperative recovery of patients with lumbar disk herniation. Methods: The clinical data of 470 inpatients who underwent tubular microdiscectomy (TMD) between January 2018 and January 2021 were retrospectively analyzed as variables. The dataset was randomly divided into a training set (n = 329) and a test set (n = 141) using a 10-fold cross-validation technique. Various deep learning and machine learning algorithms including Random Forests, Extreme Gradient Boosting, Support Vector Machines, Extra Trees, K-Nearest Neighbors, Logistic Regression, Light Gradient Boosting Machine, and MLP (Artificial Neural Networks) were employed to develop predictive models for the recovery of patients with lumbar disk herniation 1 year after surgery. The cure rate score of lumbar JOA score 1 year after TMD was used as an outcome indicator. The primary evaluation metric was the area under the receiver operating characteristic curve (AUC), with additional measures including decision curve analysis (DCA), accuracy, sensitivity, specificity, and others. Results: The heat map of the correlation matrix revealed low inter-feature correlation. The predictive model employing both machine learning and deep learning algorithms was constructed using 15 variables after feature engineering. Among the eight algorithms utilized, the MLP algorithm demonstrated the best performance. Conclusion: Our study findings demonstrate that the MLP algorithm provides superior predictive performance for the recovery of patients with lumbar disk herniation 1 year after surgery.

Evaluating the Efficacy of Antibiotic Therapy in Non-responsive Sacroiliitis: A Comparative Study.

BACKGROUND: Sacroiliitis, characterized by inflammation of the sacroiliac joints, poses significant challenges in management, especially in patients unresponsive to standard therapies like non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. This study aimed to evaluate the efficacy of antibiotic therapy in such patients, addressing a critical gap in the current treatment approach. METHODS: A total of 360 patients with lower back pain who presented to the outpatient department (OPD) of the Department of Orthopedics of a medical college in Northern India for six months were included in this study. With meticulous history taking, clinical examination, and radiological evaluation, 59 patients were diagnosed with sacroiliitis, out of which 31 were males and 28 were females, aged between 20 and 40 years, and were enrolled in this cross-sectional comparative study. Patients were divided into two groups: a control group (21 patients) receiving conventional treatment without antibiotics and a study group (38 patients) receiving conventional treatment plus antibiotics (who gave consent for treatment with antibiotics). The primary outcome was assessed using the Japanese Orthopaedic Association (JOA) score, with evaluations conducted at baseline, one month, and three months. Recovery rates were also calculated. SPSS trial software version 27 (IBM Corp., Armonk, NY) was used for statistical analysis. RESULTS: Both groups exhibited improvement in JOA scores over time. At the one-month and three-month follow-ups, the mean JOA scores and recovery rates showed no statistically significant difference between the control and study groups (p-values > 0.05). Adverse effects related to antibiotic use were not significant. CONCLUSION: The study concludes that the addition of antibiotics to the conventional treatment regimen for sacroiliitis does not provide significant benefit in terms of functional recovery or pain relief in patients non-responsive to NSAIDs and/or physical therapy. These findings underscore the importance of a targeted treatment approach based on the specific etiology of sacroiliitis and caution against unnecessary antibiotic use.

Efficacy of Daiwenjiu ointment on the treatment of cervical spondylosis with nerve root type caused by cold dampness obstruction.

OBJECTIVE: This study aimed to assess the clinical efficacy of Daiwenjiu ointment in the treatment of cervical spondylosis with cold dampness obstruction nerve root type. METHODS: A retrospective analysis was conducted on a cohort of 110 patients diagnosed with cervical spondylotic radiculopathy. Based on the treatment method, the patients were divided into two groups. The control group received electroacupuncture treatment, while the observation group received a combination of Daiwenjiu ointment and electroacupuncture treatment. The outcome measures included Japanese Orthopedic Association (JOA) scores for cervical spine function, Simplified McGill Pain Questionnaire (SF-MPQ) scores, and changes in serum inflammatory factors TNF-α and IL-1ß. RESULTS: Following treatment, the JOA score in the observation group increased from 9.45 ± 1.35 to 14.82 ± 1.29 after treatment, indicating better recovery of cervical spine function compared to the control group (p < 0.001). The SF-MPQ score in the observation group decreased to 18.25 ± 3.80 after treatment, while it remained at 30.20 ± 4.30 in the control group. This difference between the groups was statistically significant (p < 0.001). Furthermore, the observation group demonstrated a significant decrease in serum levels of TNF-α and IL-1ß after treatment compared to the control group (p < 0.001). CONCLUSION: Daiwenjiu ointment exhibits significant therapeutic effects in patients with cold dampness obstruction nerve root type cervical spondylosis. It effectively improves cervical function, reduces pain, and downregulates inflammatory cytokine levels.

Clinical outcome of surgical management of mild cervical compressive myelopathy based on minimum clinically important difference.

BACKGROUND CONTEXT: Cervical compressive myelopathy (CCM), caused by cervical spondylosis (cervical spondylotic myelopathy [CSM]) or ossification of the posterior longitudinal ligament (OPLL), is a common neurological disorder in the elderly. For moderate/severe CCM, surgical management has been the first-line therapeutic option. Recently, surgical management is also recommended for mild CCM, and a few studies have reported the surgical outcome for this clinical population. Nonetheless, the present knowledge is insufficient to determine the specific surgical outcome of mild CCM. PURPOSE: To examine the surgical outcomes of mild CCM while considering the minimum clinically important difference (MCID). STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Patients who underwent subaxial cervical surgery for CCM caused by CSM and OPLL between 2013 and 2022 were enrolled. OUTCOME MEASURES: The Japanese Orthopedic Association score (JOA score) was employed as the clinical outcomes. Based on previous reports, the JOA score threshold to determine mild myelopathic symptoms was set at ≥14.5 points, and the MCID of the JOA score for mild CCM was set at 1 point. METHODS: The patients with a JOA score of ≥14.5 points at baseline were stratified into the mild CCM and were examined while considering the MCID. The mild CCM cohort was dichotomized into the improvement group, including the patients with an achieved MCID (JOA score ≥1 point) or with a JOA score of 17 points (full mark) at 1 year postoperatively, and the nonimprovement group, including the others. Demographics, symptomatology, radiographic findings, and surgical procedure were compared between the two groups and studied using the receiver operating characteristic (ROC) curve. RESULTS: Of 335 patients with CCM, 43 were stratified into the mild CCM cohort (mean age, 58.5 years; 62.8% male). Among them, 25 (58.1 %) patients were assigned to the improvement group and 18 (41.9 %) were assigned to the nonimprovement group. The improvement group was significantly younger than the nonimprovement group; however, other variables did not significantly differ. ROC curve analysis showed that the optimal cutoff point of the patient's age to discriminate between the improvement and nonimprovement groups was 58 years with an area under the curve of 0.702 (p=.015). CONCLUSIONS: In the present study, the majority of patients with mild CCM experienced improvement reaching the MCID of JOA score at 1 year postoperatively. The present study suggests that for younger patients with mild CCM, especially those aged below 58 years, subjective neurological recovery is more likely to be obtained. Meanwhile, the surgery takes on a more prophylactic significance to halt disease progression for older patients. The results of this study can help in the decision-making process for this clinical population.

Assessing Range of Motion Gap in Circumferential Surgery for Cervical Myelopathy due to Ossification of the Posterior Longitudinal Ligament.

OBJECTIVE: Only a few studies have investigated the gap range of motion (gROM) in cervical myelopathy or deformity caused by ossification of the posterior longitudinal ligament (OPLL). The aim of this study is to investigate the correlation between the individual gROM and the postoperative clinical outcomes of patients with OPLL. METHODS: Consecutive patients of cervical myelopathy caused by OPLL were analyzed retrospectively. The clinical outcomes were evaluated using Visual Analogue Scale scores of the neck and arm pain and the Japanese Orthopaedic Association scores. Radiologic measurements included flexion ROM (fROM), which was defined as the difference of cervical lordosis in flexion and neutral positions, extension ROM (eROM), defined as the difference between neutral and extension positions, and gROM, defined as the difference between fROM and eROM. Patients were grouped by the values of gROM, and comparisons of all outcomes were made between the groups. RESULTS: A total of 42 patients underwent surgery. The patients with greater gROM did not differ from those with smaller gROM by demographic characteristics. During follow-up (mean 45.8 months), both groups had similar improvements, but the C5 palsy rates were higher in the greater gROM group than in the smaller gROM group (71% and 22%, P < 0.05). CONCLUSIONS: Simultaneous circumferential decompression and fixation is an effective surgical option for patients with cervical myelopathy caused by OPLL. A higher rate of postoperative C5 palsy was observed in the patients with greater gROMs after surgery, although all patients presented with similar clinical improvements.

Gait Analysis by the Severity of Gait Disturbance in Patients with Compressive Cervical Myelopathy.

Introduction: Gait disturbance due to compressive cervical myelopathy has been previously described. However, data on how gait disturbance varies with the degree of lower extremity motor impairment are limited. Therefore, we investigated the characteristics of gait analysis based on severity and determined how gait disturbance progresses in compressive cervical myelopathy. Methods: We enrolled 44 patients (32 men and 12 women; mean age, 65.0 years) out of 108 consecutive patients with compressive cervical myelopathy who underwent spinal cord decompression surgery in our hospital. The exclusion criteria were inability to gait and complications affecting gait. Twenty-two patients with Japanese Orthopaedic Association scores 1 or 2 for lower extremity motor functions were assigned to the severe group, and 22 patients who scored 3 or 4 were assigned to the moderate group. Gait analysis was performed preoperatively using a long thin-type sensor sheet, and 25 healthy volunteers were assigned to the control group. Results: Stride length, swing phase, and gait speed decreased whereas step angle, stance phase, and double support duration increased as myelopathy progressed. Step width was significantly larger in the severe group than in the moderate and control groups. The cutoff values based on severe myelopathy with the inability to ascend or descend stairs without support were 60% for the stride length percentage of body height and 100 cm/s for gait speed. Conclusions: Decreases in stride length, swing phase, and gait speed and increases in step angle, stance phase, and double support duration are compensatory changes as cervical myelopathy progresses. Step width is a compensatory change that is not significantly altered in moderate myelopathy but increases when gait becomes affected, such that the patient cannot ascend or descend stairs without support.

Effect of vitamin D deficiency on surgical outcomes of degenerative cervical myelopathy.

Background: Due to its association with bone metabolic status and muscle strength/mass, vitamin D deficiency has the potential to affect neurological symptom recovery after surgery for degenerative cervical myelopathy (DCM). However, few studies have investigated the effects of vitamin D deficiency (serum 25(OH)D <20 ng/mL) on surgical outcomes in DCM patients. Herein, we investigated the prevalence of vitamin D deficiency in patients with DCM, and determined whether vitamin D deficiency affects surgical outcomes for DCM. Methods: In this retrospective observational study we assessed the recovery rate 1 year after surgery in 91 patients diagnosed with DCM who underwent surgery. First, we analyzed the correlation between vitamin D levels and various background factors. Then, patients were divided into 2 groups according to vitamin D sufficiency, and univariate analysis was performed on vitamin D and surgical outcomes. Finally, Spearman correlation analyses were performed to identify factors correlated with recovery rate after surgery for DCM. Results: The average Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score) improved postoperatively. Age was positively correlated with vitamin D levels, and parathyroid hormone levels were negatively correlated with vitamin D levels. Among the 91 patients, 79.1% of patients were diagnosed with vitamin D deficiency. No significant differences in recovery rate were found between the vitamin D-deficient and vitamin D-sufficient groups. Finally, the Spearman correlation analysis showed a positive correlation between the preoperative C-JOA motor dysfunction score in the lower extremities and the recovery rate, while age demonstrated a negative correlation with recovery rate. Conclusions: No association was found between vitamin D deficiency and clinical outcomes after surgery for DCM. The results of this study do not support the need to normalize vitamin D levels for achieving neurological improvements in patients with DCM.

Adaptation and Limitations of painDETECT Questionnaire Score Approach Before and After Posterior Cervical Decompression Surgery.

BACKGROUND: The painDETECT questionnaire (PDQ) is one of the available screening tools for neuropathic pain (NeP), with a cut-off score of 13. This study aimed to investigate changes in PDQ scores in patients undergoing posterior cervical decompression surgery for degenerative cervical myelopathy (DCM). METHODS: Patients with DCM undergoing cervical laminoplasty or laminectomy with posterior fusion were recruited. They were asked to complete a booklet questionnaire including PDQ and Numerical Rating Scales (NRS) for pain at baseline and one year after surgery. Patients with a preoperative PDQ score ≥13 were further investigated. RESULTS: A total of 131 patients (mean age = 70.1 years; 77 male and 54 female) were analyzed. After posterior cervical decompression surgery for DCM, mean PDQ scores decreased from 8.93 to 7.28 (P = 0.008) in all patients. Of the 35 patients (27%) with preoperative PDQ scores ≥13, mean PDQ changed from 18.83 to 12.09 (P < 0.001). Comparing the NeP improved group (17 patients with postoperative PDQ scores ≤12) with the NeP residual group (18 patients with postoperative PDQ scores ≥13), the NeP improved group showed less preoperative neck pain (2.8 vs. 4.4, P = 0.043) compared to the NeP residual group. There was no difference in the postoperative satisfaction rate between the two groups. CONCLUSIONS: Approximately 30% of patients exhibited preoperative PDQ scores ≥13, and about half of these patients demonstrated improvements to below to the cut-off value for NeP after posterior cervical decompression surgery. The PDQ score change was relatively associated with preoperative neck pain.

Resection of Cervical Dumbbell-Shaped Schwannoma Using Posterior Unilateral Approach: Impact on Postoperative Cervical Function and Clinical Outcomes.

STUDY DESIGN: A retrospective comparative study. OBJECTIVES: This study aimed to evaluate the radiographical changes in cervical sagittal alignment (CSA) and clinical outcomes after tumor resection using a posterior unilateral approach without spinal fixation for patients with cervical dumbbell-shaped schwannoma (DS). METHODS: Seventy-three patients with DS who were followed up for at least 2 years were included. The Eden classification was used to designate the types of DS. The CSA and range of motion (ROM) were analyzed using radiographs. The clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and JOA cervical myelopathy questionnaire. RESULTS: The CSA in the neutral, flexion, and extension position and cervical ROM were not significantly reduced in the follow-up period. The JOA scores showed significant improvement after surgery. The postoperative radiographic parameters and clinical outcomes of Eden type II or III DS, which needed facetectomy for the resection, did not show any statistically significant difference compared with those of Eden type I tumor, which was resected without facetectomy. Fifty-two cases (71.2%) achieved gross total resection, whereas 21 cases (28.8%) remained in partial resection (PR). One case underwent reoperation due to the regrowth of the remnant tumor whose margin was at the entrance of the intervertebral foramen. CONCLUSIONS: Tumor resection using the posterior unilateral approach preserved CSA and resulted in favorable clinical outcomes in patients with DS. When the resection ends in PR, the proximal margin of the remnant tumor should be located distally away from the entrance of the foramen to prevent regrowth.

Changes of improvement in upper limb function predict surgical outcome after laminoplasty in 1 year in patients with cervical spondylotic myelopathy: a retrospective study.

BACKGROUND: Cervical spondylotic myelopathy preoperative prognostic factors include age, preoperative severity, and disease duration. However, there are no reports on the relationship between changes in physical function during hospitalization and postoperative course, and in recent years, the length of hospital stay has shortened. We aimed to investigate whether changes in physical function during hospitalization can predict the postoperative outcome. METHODS: We recruited 104 patients who underwent laminoplasty for cervical spondylotic myelopathy by the same surgeon. Physical functions, including Simple Test for Evaluating Hand Function (STEF), grip strength, timed up and go test, 10-m walk, and time to stand on one leg, were assessed at admission and discharge. Patients with the Japanese Orthopaedic Association (JOA) score improvement rate of 50% or more were defined as the improved group. Decision tree analysis was investigated factor for identifying improvement in the JOA score. According to this analysis, we divided into two groups using age. Then, we conducted a logistic regression analysis to identify factors that improve the JOA score. RESULTS: The improved and non-improved groups had 31 and 73 patients, respectively. The improved group was younger (p = 0.003) and had better improved Δgrip strength (p = 0.001) and ΔSTEF (p < .0007). Age was significantly positively correlated with disease duration (r = 0.4881, p = < .001). Disease duration exhibited a significant negative correlation with the JOA score improvement rate (r = - 0.2127, p = 0.031). Based on the decision tree analysis results, age was the first branching variable, with 15% of patients ≥ 67 years showing JOA score improvement. This was followed by ΔSTEF as the second branching factor. ΔSTEF was selected as the factor associated with JOA improvement in patients ≥ 67 years (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.90-0.99, p = .047); in patients < 67 years, Δgrip strength was identified (OR 0.53, CI 0.33‒0.85, p = .0086). CONCLUSIONS: In the improved group, upper limb function improved more than lower limb function from the early postoperative period. Upper limb function changes during hospitalization were associated with outcomes one year postoperatively. Improvement factors in upper extremity function differed by age, with changes in grip strength in patients < 67 years and STEF in patients ≥ 67 years, reflecting the outcome at one year postoperatively.

Flexional distance index: A new prognostic indicator of neurological outcomes at 4 years after cervical laminoplasty for K-line (+) ossification of the posterior longitudinal ligament.

OBJECTIVE: We aimed to investigate whether K-line in the neck flexion (FK-line), flexion angle (FA), or flexion distance index (FDI) could predict the recovery rate of the Japanese Orthopedic Association score (RR-JOA) at 4 years after cervical laminoplasty (LP) for ossification of the posterior longitudinal ligament (OPLL). METHODS: A new index, i.e., the FDI, which is based on the degree of neck flexion and the OPLL size on a lateral radiograph. "Flexional distance" is the distance from C2 to C7 in neck flexion, and "distance to OPLL" is the maximal distance from the line of the flexional distance to OPLL. FDI was defined as follows: FDI = flexional distance/distance to OPLL. Twenty-three patients with K-line (+) OPLL were evaluated at 4 years after LP (follow-up rate, 92%). We investigated the relationships between preoperative radiological factors, including FK-line, FA, and FDI, and RR-JOA at 4 years postoperatively. RESULTS: Preoperative FK-line and FA were significantly related with the RR-JOA at 1 year postoperatively, but not at 4 years postoperatively. Preoperative FDI was significantly positively correlated with the RR-JOA at 1 year and 4 years postoperatively (P = 0.0132, r = 0.504 and P = 0.0183, r = 0.484, respectively). Preoperative FDI < 2.5 was associated with worsening of the RR-JOA at 4 years postoperatively, with a probability of 80% DISCUSSIONS: FDI could predict the RR-JOA at 4 years after LP for OPLL. Decompression with fusion may be recommended for patients with preoperative FDI < 2.5. LEVEL OF EVIDENCE: 4.

Comparison of Surgical Outcomes Between Staged and Simultaneous Decompression of Discontinuous Thoracic Ossification of the Ligamentum Flavum: A Retrospective Study.

BACKGROUND: Discontinuous thoracic ossification of the ligamentum flavum (TOLF) is diagnosed according to the number and distribution of involved segments seen on magnetic resonance images. When TOLF causes thoracic myelopathy, surgical intervention for these lesions becomes unavoidable. However, there are few reports on the outcomes of surgery for discontinuous TOLF. METHODS: The study included 26 patients of mean age 55.0 years who underwent simultaneous (n = 16) or staged (n = 10) decompression of discontinuous TOLF between July 2006 and June 2016. Final neurologic status was evaluated using the modified Japanese Orthopaedic Association (JOA) score. The surgical data and incidence of complications were compared. The mean follow-up duration was 73.3 months. RESULTS: There was no between-group difference in number of levels decompressed or the amount of intraoperative blood loss. There was a significant improvement in the JOA score from 4.0 before surgery to 8.0 postoperatively, with an average recovery rate of 58.3%. The JOA recovery rate was significantly better in the staged group than simultaneous group (68.4% vs. 52.0%, P < 0.05). However, the incidence of complications was similar between the staged and simultaneous groups including for dural tear (1 vs. 6, P = 0.19), cerebrospinal fluid leak (4 vs. 6, P = 1.00), and transient neurologic deterioration (0 vs. 2, P = 0.51). CONCLUSIONS: The surgical outcome of staged decompression for discontinuous TOLF seems to be better than that of simultaneous decompression. The complication rates of these 2 strategies are similar.

Effects of unilateral and bilateral pedicle screw fixation on symptoms and quality of life of patients with lumbar degenerative diseases.

OBJECTIVE: This research was designed to probe into the effects of unilateral and bilateral pedicle screw fixation on the VAS scores of low back pain, leg pain, ODI indexes and JOA scores in patients with lumbar degenerative diseases. METHODS: Totally 113 patients with lumbar degenerative diseases admitted in our hospital from February 2016 to December 2018 were collected as the research objects. Among them, 52 received bilateral pedicle screw fixation (BPSF) and 61 were treated by unilateral pedicle screw fixation (UPSF). The intraoperative blood loss, time of operation and hospitalization, and incidence of perioperative complications of the two groups were compared. The VAS scores, ODI indexes and JOA scores were assessed before operation and 6 and 12 months after treatment. The intervertebral fusion rates were compared, and the quality of life was evaluated by SF-36. RESULTS: The intraoperative blood loss in the observation group (OG) was higher than that in the control group (CG) (P<0.05), while the time of operation and hospital stay were obviously shorter (P<0.05). There was no marked difference in the incidence of perioperative complications (P>0.05). Before treatment, there was no remarkable difference in the VAS scores of low back pain, leg pain, ODI indexes and JOA scores (P>0.05). At 6 and 12 months after treatment, the first two parameters were remarkably lower than those before treatment, but the rest of the parameters were dramatically higher (P<0.05). The VAS scores and ODI indexes of the OG were markedly lower than those of the CG, while the JOA scores, fusion rates and quality of life were obviously higher (P<0.05). CONCLUSION: Bilateral pedicle screw fixation is valid and safe on lumbar degenerative diseases, which can improve patients' quality of life.

Clinical Comparison of Selective versus Nonselective Decompression for Symptomatic Tandem Stenosis of the Cervical and Thoracic Spine: A Retrospective Cohort Study.

OBJECTIVE: The aim of the present paper was to reveal the clinical differences between selective and nonselective decompression for symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS). METHODS: A total of 34 patients were eligible and included in the study. Among them, 8 patients underwent selective cervical decompression (CD), 15 patients underwent selective thoracic decompression (TD), and 11 patients underwent combined CD and TD (CTD) surgery. Age, sex, operative time, intraoperative blood loss, postoperative hospital stay, inpatient expenditure, preoperative upper Japanese Orthopaedic Association (JOA) rate, canal occupation rate, high-intensity T2-weighted image (T2WI) of the spinal cord, and preoperative and postoperative JOA scores were compared among the three groups. RESULTS: The CD group had shorter operative time (138.8 ± 36.1 vs 229.7 ± 95.8 vs 328.6 ± 94.8, min, P < 0.001), less intraoperative blood loss (141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5, mL, P = 0.004), and shorter postoperative hospital stay (4.6 ± 1.6 vs 9.0 ± 3.5 vs 10.3 ± 6.6, days, P = 0.008), as well as lower preoperative upper JOA rate (34.1 ± 5.6 vs 53.9 ± 8.4 vs 48.2 ± 15.2, %, P = 0.001) than the TD and CTD groups. The CTD group had higher inpatient expenditure than the CD and TD groups (87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715, CNY, P < 0.001). The cervical canal occupation rates were similar among different groups (P > 0.05); however, the TD group showed a higher thoracic canal occupation rate than the CD group (58.3 ± 14.7 vs 43.3 ± 12.3, %, P = 0.035). All positive levels in high-intensity T2WI of the spinal cord were decompressed. The preoperative JOA scores as well as the postoperative JOA scores at 6 months and at last follow-up were comparable among the three groups (P > 0.05). Similarly, the JOA recovery rate showed no significant difference among the groups (P > 0.05). CONCLUSION: Selective CD or TD alone demonstrated similar clinical effectiveness to nonselective and combined CTD for TSCTS. Individualized surgical decision should be made after meticulous assessments of clinical and radiological manifestations, general patient condition, and socioeconomic factors.

Comparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation.

BACKGROUND: Due to the limited number of reports comparing posterior fusion with posterior decompression alone for retro-odontoid pseudotumor, there remains no consensus on treatment preference, especially in older patients. This study compared posterior fusion (with or without additional decompression) with posterior decompression alone for treating spinal cord pressure from non-inflammatory retro-odontoid pseudotumor with atlanto-axial subluxation (AAS). METHODS: Forty-one patients (27 male and 14 female; mean age, 73.0 ± 11.4 years) who underwent either posterior cervical fusion or decompression alone for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS and were observed for more than 1 year between September 2009 and July 2019 were enrolled. Thirty-two patients (23 male and 9 female; mean age: 71.8 ± 10.9 years) received posterior fusion surgery (fusion group) and 9 patients (4 male and 5 female; mean age: 77.2 ± 12.5 years) underwent decompression alone (non-fusion group). We compared pre- and postoperative Japanese Orthopaedic Association (JOA) scores and preoperative cervical alignment parameters between the groups. RESULTS: In the fusion group, the mean preoperative JOA score was significantly improved from 9.0 ± 3.2 points to 11.7 ± 3.2 points at the final follow-up (p = 0.0002). Similarly in the non-fusion group, the mean preoperative and final follow-up JOA scores were 8.2 ± 3.5 points and 11.7 ± 3.8 points, respectively (p = 0.003). The recovery rate at the final follow-up was 22.6% in the fusion group and 43.4% in the non-fusion group, which were statistically comparable (p = 0.23). We observed no remarkable correlations between cervical sagittal spinal alignment parameters and JOA score recovery rate in the cohort, nor was any significant subluxation progression seen. CONCLUSION: Compared with fusion surgery, surgical decompression alone may be a suitable and less invasive option for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS, especially in elderly patients.

Factors Influencing Patient Satisfaction After Decompression Surgery Without Fusion for Lumbar Spinal Stenosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients. METHODS: We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed. RESULTS: Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form-8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction. CONCLUSIONS: Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.

Therapeutic effect of Yaotongning Capsules and thunder-fire moxibustion in treatment of 40 cases of lumbar disc herniation with cold and blood-stasis syndrome / 中草药

Objective: To explore the clinical efficacy effect of Yaotongning Capsules combined with thunder-fire moxibustion on lumbar disc herniation (LDH). Methods: A total of 80 LDH patients who met the inclusion criteria were randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with Yaotongning Capsules combined with thunder-fire moxibustion, and the control group was treated with ibuprofen sustained release capsule combined with thunder-fire moxibustion. VAS score, JOA score, ODI score and clinical efficacy were compared. Results: VAS scores and ODI scores of the two groups after treatment were lower than those before treatment (P < 0.05), and the JOA score was higher than that before treatment (P < 0.05); After treatment, the VAS score and ODI score in the observation group were lower than those in the control group (P < 0.05); After treatment, the JOA score was higher than that in the control group (P < 0.05). The clinical efficacy of the observation group was better than that of the control group (P < 0.05). Conclusion: The clinical treatment of Yaotongning Capsules combined with thunder-fire moxibustion treating LDH can obviously alleviate the pain symptoms and improve the daily function of the patients, which is worthy of further clinical application.

Total knee arthroplasty in Japanese patients aged 80 years or older.

OBJECTIVE: The population of Japan is aging rapidly, and, since the aging of patients who undergo total knee arthroplasty (TKA) is also expected, it is necessary to determine the efficacy and safety of TKA among old adult patients. METHODS: This study retrospectively analyzed the cases of patients who underwent a primary TKA for osteoarthritis at Bange Kosei General Hospital between January 2009 and June 2014 and were postoperatively followed-up for ≥1 year. Among the 2,945 knees of the 1,968 patients, 1,003 knees of 679 patients aged ≥80 years at the time of surgery were designated as the older group, and we compared their cases with those of the younger group of 1,044 knees of 673 patients aged <75 years. RESULTS: The rates of improvement of the Japanese Orthopaedic Association (JOA) score were not significantly different between the older and younger groups. Postoperative ranges of motion were significantly improved in both groups. The number of postoperative days of hospital stay in the older group was 2 days longer than that of the younger group. Concerning postoperative complications, confusion, delayed wound healing, and acute heart failure were significantly more frequent in the older group. The frequencies of pneumonia, cerebral infarction, peroneal nerve palsy, and bedsore did not differ significantly. Loosening of implants was observed: older group, n=0 joints; younger group, n=5 joints. The number of prosthetic joint infections: older group, n=5; younger group, n=2 (non-significant). CONCLUSION: The rate of improvement in the JOA score did not differ significantly between the groups. TKA is an effective and safe treatment for osteoarthritis, even in old adult patients, when the surgical indication is based on careful preoperative screening and attention to specific postoperative complications.

Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament.

OBJECTIVE: T1 slope (T1S) has emerged as a predictor of kyphotic alignment change after laminoplasty. Although it was reported that patients with cervical ossification of the posterior longitudinal ligament (OPLL) and higher T1S had more pronounced lordotic curvature before surgery and higher loss of cervical lordosis after surgery, few studies have attempted to correlate these findings with clinical outcomes. We aimed to investigate the relationship of T1S with loss of cervical lordosis and surgical outcomes after laminoplasty for cervical OPLL. PATIENTS AND METHODS: 35 consecutive patients (26 men and 9 women) with cervical OPLL who underwent double-door laminoplasty were followed for more than 12 months. Radiological and clinical measurements were performed to analyze the following parameters: pre and postoperative C2-C7 Cobb lordotic angle (LA), preoperative C2-C7 range of motion (ROM), loss of cervical lordosis, percentage of change in postoperative kyphosis, pre and postoperative C2-C7 sagittal vertical axis (SVA), change in C2-C7 SVA and occupying ratio of the OPLL, Japanese Orthopedic Association (JOA) score recovery rate, preoperative MRI grade. RESULTS: Patients were divided into 2 groups according to preoperative T1 slope, with the cutoff value being the average preoperative T1 slope. Preoperative C2-C7 Cobb LA (P=0.007) and loss of cervical lordosis (P=0.034) differed between the two groups. Preoperative C2-C7 Cobb LA (R=0.50, P=0.002) and loss of cervical lordosis (R=0.36, P=0.036) were significantly correlated to preoperative T1S. Multivariate linear regression analysis showed that the preoperative T1S was not related to JOA score recovery rate and the preoperative MRI grade (OR=-9.985, P=0.015) was only related to JOA score recovery rate. CONCLUSION: Although the degree of alignment compromise is correlated with the preoperative T1S, clinical outcomes demonstrate overall improvement after cervical laminoplasty with cervical OPLL, regardless of preoperative T1S.

Efficacy of percutaneous intervertebral foramen and TLIF in treatment of extreme lateral lumbar disc herniation / 局解手术学杂志

Objective To evaluate the clinical effect of percutaneous intervertebral foramen and TLIF in the treatment of extreme lateral lumbar disc herniation and the SF-36 score.Methods A total of 90 patients with extreme lateral lumbar disc herniation admitted in our hos-pital from March 2015 to March 2017 were selected as the subjects,who were divided into the control group ( traditional therapy) and the study group(percutaneous intervertebral foramen treatment), according to the different surgical methods,45 cases in each group.The treat-ment,pain,SF-36 score and other indicators of two groups were observed.Results The rate of excellence and good was 97.78% in the study group and 86.67% in the control group,the difference was significant(P<0.05).The blood loss was (46.83 ± 3.64)mL in the study group and (79.32 ±5.47)mL in the control group,the difference was significant(P<0.05).There was no significant difference in the scores of SF-36 and JOA between the two groups(P>0.05).After treatment,the two groups were significantly improved(P<0.05),the improvement rate of the study group was more obvious (P<0.05).After treatment,TNF-α,IL-6 and CRP levels were significantly better than those in the control group (P<0.05).Conclusion Percutaneous intervertebral foramen treatment of extreme lateral lumbar disc herniation can reduce the intraoperative blood loss and improve the quality of life