RESUMO
OBJECTIVE: To validate with a prospective study a decision-supporting coding system for the surgical approach for multilevel degenerative cervical myelopathy. METHODS: Ten cases were presented on an internet platform, including clinical and imaging data. A single-approach (G1), a choice between 2 (G2), or 3 approaches (G3) were options. Senior and junior spine surgeons analyzed 7 parameters: location and extension of the compression of the spinal cord, C-spine alignment and instability, general morbidity and bone diseases, and K-line and multilevel corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting 7-letter code (7LC) suggested the surgical approach. Each surgeon performed 2 reads per case within 8 weeks. RESULTS: G1: Interrater reliability between junior surgeons improved from the first read (κ = 0.40) to the second (κ = 0.76, p < 0.001) but did not change between senior surgeons (κ = 0.85). The intrarater reliability was similar for junior (κ = 0.78) and senior (κ = 0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice. CONCLUSION: The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.
RESUMO
AIM: The morbidity and mortality after a hip fracture in the elderly population are multifactorial. The aim of this study is to determine the long-term impact of specific factors to mortality rate and mobility after a hip fracture in the elderly. MATERIALS AND METHODS: Elderly suffering a hip fracture after a low-energy trauma was included in the study, whereas moribund patients with severe comorbid conditions and high-energy trauma were excluded. All the patients were treated operatively during 2003. Data for survivorship and mobilization was collected six months, one and ten years after the operation. Kaplan-Meier log rang test was used for the survival analysis and cox regression for multivariate analysis of prediction factors such as age, gender, time to surgery after trauma, type of fracture, ambulation status before injury and early walking ability after the surgery. RESULTS: Two hundred and thirty three patients were finally included to the study. Gender (p = 0.64) and type of fracture (p = 0.92) seem to have no statistically significant impact on survivorship. Age (p < 0.001), time of surgery after the trauma (p = 0.001), ambulation status (p < 0.001) and early walking ability after the surgery (p < 0.001) seem to have statistically significant impact on mortality, as independent factors. The significance is present one year and ten years after the surgery. However, according to the multivariate analysis, time to surgery after trauma and age lose significance, while early walking ability remain significant one and ten years after surgery (p < 0.001). Ambulation status seem to lose significance early after surgery, but reach significance ten years postoperatively (p < 0.001). CONCLUSION: In summary, it could be stated that early walking ability after an operation for a hip fracture in elderly is the most significant prediction factor of survivorship one and ten years postoperatively. Ambulation status before injury is a significant long-term predictor factor for survivorship.
