Obese people benefit from lumbar spinal stenosis surgery as much as people of normal weight.

BACKGROUND: Lumbar spinal stenosis (LSS) is a common degenerative condition of the spine that causes back pain radiating to the lower extremity. Surgical treatment is indicated to treat progressive radical symptoms. Obesity has been associated with inferior results in the domains of quality of life (QoL) following an LSS operation, but the research findings have been limited. This paper aims to identify whether obesity affects QoL due to back pain among patients who underwent an operation for LSS. METHODS: This study is based on a series of patients operated on for LSS between 2012 and 2018. Operated patients who returned for follow-up forms within the first or second years were included. A total of 359 patients were selected, 163 males (45%) and 196 females (55%). The mean age was 68.9 years. The EuroQol five-dimension scale (EQ-5D) questionnaire was chosen to measure QoL and the Oswestry Disability Index (ODI) for functional disability. RESULTS: QoL, as measured by EQ-5D, was preoperatively lower in those patients with a BMI ≥ 30. One year after the operation, all groups had a similar trend of improved QoL. At the second year, the results in all groups levelled off even though there was no statistical difference in clinical outcomes (p = 0.92). The ODI was preoperatively statistically higher in patients with a BMI ≥ 30 (p < 0.001). Two years after the surgery, all groups had improved ODI scores, but there was no statistical difference in ODI between the BMI groups (p = 0.54). CONCLUSION: Surgical intervention for debilitating or longstanding symptoms of LSS should be considered as a treatment option for suitable patients in spite of an elevated BMI.

Effects of surgical correction of neuromuscular scoliosis on gastric myoelectrical activity, emptying, and upper gastrointestinal symptoms.

OBJECTIVES: Gastrointestinal complications are frequent after surgical correction of neuromuscular scoliosis, but the effects of scoliosis surgery on gastric function and upper gastrointestinal symptoms over the long term are unknown. METHODS: Thirty-one children (16 spastic, 15 flaccid patients) who underwent surgical correction of neuromuscular scoliosis were included in a prospective follow-up study. Median (range) age at surgery was 14.9 (5-20) years and follow-up time 4.3 (2-8) years. Electrogastrography (n=28), gastric emptying scintigraphy (n=17), and structured upper gastrointestinal symptoms questionnaire (n=26) were evaluated before and after surgery. The results were related to patients' clinical state, type and extent of corrective spinal surgery, and gastrointestinal complications. RESULTS: The median main scoliosis curve of 81 degrees (51-129 degrees) was corrected to 25 degrees (1.0-85 degrees) after surgery. In electrogastrogram, power ratio increased from preoperative 1.4 (0.30-11) to postoperative 6.2 (1.2-26) in the spastic group (P=0.008), whereas in the flaccid group, power ratio remained unchanged at 2.2 (0.1-17). Patients with prolonged postoperative paralytic ileus had the most substantial increase in gastric power ratio (P=0.038). Correction of sagittal spinal balance correlated with increased postprandial normogastric activity after surgery (R=0.459; P=0.004). The gastric emptying results, upper gastrointestinal symptoms, and body mass index were not significantly altered after scoliosis surgery. CONCLUSIONS: Gastric myoelectrical power increased after surgical correction of spastic neuromuscular scoliosis and was associated with prolonged postoperative paralytic ileus. Correction of poor, stooped spinal balance improved gastric myoelectrical activity. The net effect of scoliosis surgery on gastric emptying, upper gastrointestinal symptoms, and clinical nutritional state was minimal.

Vertebral fracture and cause-specific mortality: a prospective population study of 3,210 men and 3,730 women with 30 years of follow-up.

INTRODUCTION: Vertebral fractures predict mortality, but little is known about their associations with the causes of death. We studied vertebral fractures for prediction of cause-specific mortality. MATERIAL AND METHODS: A nationally representative sample of 3,210 men and 3,730 women participated Mini-Finland health survey in 1978-1980. Vertebral fractures at the Th1-Th12 levels were identified from chest radiographs at baseline. Cox's proportional hazard model was used to estimate the strength of association between vertebral fracture and mortality. RESULTS: The relative risk (95% confidence interval) of death from natural causes was 1.49 (0.89-2.48) in men and 0.89 (0.60-1.31) in women with vertebral fractures (adjusted for age, body mass index, serum 25-hydroxyvitamin D, educational level, smoking, alcohol intake, physical activity and self-rated general health). Among women the adjusted relative risk of an injury death was 8.51 (3.48-20.77), whereas none of the men with vertebral fracture died due to an injury. CONCLUSION: The patterns of mortality predicted by fracture in the thoracic spine differ between men and women.

Hemivertebra resection for congenital scoliosis in young children: comparison of clinical, radiographic, and health-related quality of life outcomes between the anteroposterior and posterolateral approaches.

STUDY DESIGN: A retrospective comparative study of prospectively collected data. OBJECTIVE: To compare clinical, radiographic, and health-related quality of life (Scoliosis Research Society [SRS]-24) outcomes in patients undergoing hemivertebra excision by simultaneous anteroposterior (AP) or posterolateral only approach (PL). SUMMARY OF BACKGROUND DATA: AP hemivertebra resection for congenital scoliosis has provided reliable and safe long-term outcomes with respect to clinical and radiographic findings. Recently, PL excision has been described with rather high implant failure and revision rates. There are no studies comparing outcomes of AP and PL hemivertebra excision in 1 center. In addition, studies reporting health-related quality of life after surgery for congenital scoliosis are few. METHODS: Between 2001 and 2008, 12 AP and 11 PL hemivertebra excisions were conducted in 21 patients (16 males) with congenital scoliosis or kyphoscoliosis due to unbalanced hemivertebrae in our hospital. The average age at surgery was 4.0 years (range, 1.2-11.4) and the mean follow-up time 2.5 years (range, 1-7 years). RESULTS: Before surgery, the mean Cobb angle of the main curve was 33° (range, 25°-45°) in the AP group and 43° (range, 26°-87°) in the PL group. At the final follow-up visit, the main curve had been corrected to a mean of 12° (range, 2°-27°) and 15° (range, 6°-28°), respectively (P = NS). The Scoliosis Research Society-24 total scores were similar, 101 (range, 89-109) for the AP and 100 (range, 85-106) for the PL group at the final follow-up visit. Any complication was observed in 8% (1/12) of patients in the AP group and, whereas the PL group had 40% (4/10) complication rate with 2 temporary neurologic deficits, no implant failures were observed. All patients underwent spinal fusion during follow-up. CONCLUSION: PL resection is technically more demanding and slightly faster method for hemivertebral resection. It has nearly as good correction rate as the AP-method but more minor complications. Hemivertebrectomy seems to provide a controllable untethering effect in patients with a symptomatic tethered cord.

Incidence of spinal and spinal cord injuries and their surgical treatment in children and adolescents: a population-based study.

STUDY DESIGN: A population based, epidemiological study. OBJECTIVE: To investigate incidence of spinal and spinal cord injuries and their surgical treatment in children and adolescents in Finland. SUMMARY OF BACKGROUND DATA: Epidemiological data on spinal injuries and their treatment in children is sparse. METHODS: All spinal and spinal cord injuries in children under 18 years of age treated in hospital between 1997 and 2006 in Finland were included. The data on injuries, hospitalizations, and surgical treatment were collected from the National Hospital Discharge Register which includes all in-patient treatment episodes. Fatal spinal injuries were derived from the Official Cause-of-Death Statistics of Finland. RESULTS: The overall incidence of spinal injuries remained stable during the follow-up period, averaging 66 per 10 of the reference population aged below 18 years. The proportions of cervical, thoracic, and lumbar spine injuries altered with age: 64% of spinal injuries in children below 8 years of age were cervical, while in the older children lumbar (42%) and thoracic spine injuries (33%) were more common than cervical. The incidence of spinal cord injuries averaged 1.9 per 10 children. Thirty percent of the children with spinal injury underwent surgery. The annual incidence of fatal spinal injury averaged 2.4 per 10 children. CONCLUSION: Pediatric spinal and spinal cord injuries are rare. In contrast to previous literature, the most commonly affected area is lumbar spine. One-third of the children with spinal injury underwent surgery.

Mortality in the presence of a vertebral fracture, scoliosis, or Scheuermann's disease in the thoracic spine.

PURPOSE: Vertebral fractures and scoliosis, unlike Scheuermann's disease, have been associated with increased mortality. Total and cause-specific mortalities of these spinal deformities were studied to produce epidemiologic knowledge. METHODS: A population of 16,010 Finnish men and women 20 to 92 years of age participated in a health examination from 1973-1976. Their spinal deformities were assessed from chest radiographs by two radiologists. Logistic regression and Cox's model were used to estimate risk ratios and to control confounding. The follow-up period was 30 years. RESULTS: Vertebral fracture significantly predicted total mortality, and this increase in mortality was due to an excess of cancer and respiratory deaths. The increased risk of cancer death persisted even when those subjects with a history of cancer and the first 5 years of follow-up were excluded to avoid the effect of metastatic fractures, and when confounding was controlled. In this analysis the relative risk of cancer death in subjects with a baseline vertebral fracture was 2.02 (95% confidence interval: 1.23-3.31). CONCLUSION: Vertebral fracture significantly predicted increased mortality from cancer. To clarify the mechanism, the fractures should be studied further for their associations with defined and site-specific cancer types.