Association Between Text Neck and Neck Pain in Adults

xloma.fota13 shared this article with you from Inoreader Association Between Text Neck and Neck Pain in Adults Via Spine - Featured Articles - Featured Articles Study Design. Observational cross-sectional study. Objective. The aim of this study was to investigate the association between text neck and neck pain (NP) in adults. Summary of Background Data. It has been hypothesized that the inappropriate neck posture adopted when texting and reading on a smartphone, called text neck, is related to the increased prevalence of NP. Methods. The sample was composed of 582 volunteers aged between 18 and 65 years. Sociodemographics, anthropometrics, lifestyle, psychosocial, NP, and smartphone use-related questions were assessed by a self-reported questionnaire. Text neck was assessed by measuring the cervical flexion angle of the participants standing and sitting while typing a text on their smartphones, using the Cervical Range of Motion (CROM) device. Results. Multiple logistic regression analysis and linear regression analysis showed the cervical flexion angle of the standing participant using a smartphone did not associate with the prevalence of NP (odds ratio [OR] = 1.00; 95% confidence interval [CI]: 0.98–1.02; P = 0.66), NP frequency (OR = 1.01; 95% CI: 1.00–1.03; P = 0.056), or maximum NP intensity (beta coefficient = −5.195 × 10−5; 95% CI: −0.02 to 0.02; P = 0.99). Also, the cervical flexion angle of the sitting participant using the smartphone did not associate with NP (OR = 0.99; 95% CI: 0.98–1.01; P = 0.93), NP frequency (OR = 1.01; 95% CI: 0.99–1.02; P = 0.13), or maximum NP intensity (beta coefficient = 0.002; 95% CI: −0.002 to 0.02; P = 0.71). Conclusion. Text neck was not associated with prevalence of NP, NP frequency, or maximum NP intensity in adults. Level of Evidence: 4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters

xloma.fota13 shared this article with you from Inoreader Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters Via Spine - Featured Articles - Featured Articles Study Design. Retrospective descriptive, multicenter study. Objective. The aim of this study was to predict the three-dimensional (3D) radiographic outcomes of the spinal surgery in a cohort of adolescent idiopathic scoliosis (AIS) as a function preoperative spinal parameters and surgeon modifiable factors. Summary of Background Data. Current guidelines for posterior spinal fusion surgery (PSF) in AIS patients are based on two-dimensional classification of the spinal curves. Despite the high success rate, the prediction of the 3D spinal alignment at the follow-ups remains inconclusive. A data-driven surgical decision-making method that determines the combination of the surgical procedures and preoperative patient specific parameters that leads to a specific 3D global spinal alignment outcomes at the follow-ups can lessen the burden of surgical planning and improve patient satisfaction by setting expectations prior to surgery. Methods. A dataset of 371 AIS patients who underwent a PSF with two-year follow-up were included. Demographics, 2D radiographic spinal and pelvic measurements, clinical measurements of the trunk shape, and the surgical procedures were collected prospectively. A previously developed classification of the preoperative global 3D spinal alignment was used as an additional predictor. The 3D spinal alignment (vertebral positions and rotations) at two-year follow-up was used as the predicted outcome. An ensemble learner was used to predict the 3D spinal alignment at two-year follow-up as a function of the preoperative parameters with and without considering the surgeon modifiable factors. Results. The preoperative and surgical factors predicted three clusters of 3D surgical outcomes with an accuracy of 75%. The prediction accuracy decreased to 64% when only preoperative factors, without the surgical factors, were used in the model. Predictor importance analysis determined that preoperative distal junctional kyphosis, pelvic sagittal parameters, end-instrumented vertebra (EIV) angulation and translation, and the preoperative 3D clusters are the most important patient-specific predictors of the outcomes. Three surgical factors, upper and lower instrumented vertebrae, and the operating surgeon, were important surgical predictors. The role of surgeon in achieving a certain outcome clusters for specific ranges of preoperative T10-L2 kyphosis, EIV angulation and translation, thoracic and lumbar flexibilities, and patient's height was significant. Conclusion. Both preoperative patient-specific and surgeon modifiable parameters predicted the 3D global spinal alignment at two-year post PSF. Surgeon was determined as a predictor of the outcomes despite including 20 factors in the analysis that described the surgical moves. Methods to quantify the differences between the implemented surgeon modifiable factors are essential to improve outcome prediction in AIS spinal surgery. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Alcohol Abuse and Alcohol Withdrawal Are Associated with Adverse Perioperative Outcomes Following Elective Spine Fusion Surgery

xloma.fota13 shared this article with you from Inoreader Alcohol Abuse and Alcohol Withdrawal Are Associated with Adverse Perioperative Outcomes Following Elective Spine Fusion Surgery Via Spine - Featured Articles - Featured Articles Study Design. Cross-sectional study. Objective. Alcohol abuse (AA) and alcohol withdrawal (AW), both belonging to alcohol use disorders, bring about vast health consequences, social issues, and financial burden in United States. This study aims to explore the relationship of AA and AW with perioperative outcomes following elective spine fusion surgery. Summary of Background Data. Large studies evaluating the outcomes of spine surgery in patients with AA or AW are lacking. Methods. We used the National Inpatient Sample (NIS) from 2006 to 2014 to extract records with a primary procedure of spinal fusion surgery. Multivariable regression analysis was used to assess the association of AA and AW with in-hospital mortality, perioperative complications, cost and length of stay (LOS). Results. Among 3,132,192 patients undergoing elective spinal fusion surgery, the prevalence of AA and AW was 1.14% (35,833) and 0.15% (4623), respectively. Among the AA admissions, 12.90% of patients developed AW. The incidence of overall complications was 6.14%, 10.15%, and 33.73% in patients without AA, with AA and with AW, respectively. After multivariable adjustment, AW was associated with elevated risk of overall complications (odds ratio [OR]: 4.51; 95% confidence interval [CI]: 3.86–5.27), neurologic (OR: 2.58; 95% CI: 1.62–4.12), respiratory (OR: 8.04; 95% CI: 6.62–9.77), cardiac (OR: 3.58; 95% CI: 2.60–4.93), gastrointestinal (OR: 2.31; 95%CI: 1.68–3.17), urinary and renal (OR: 2.68; 95% CI: 2.11–3.39), venous thromboembolism (OR: 3.06; 95% CI: 1.94–4.82), wound-related complications (OR: 3.84; 95% CI: 2.96–4.98) and in-hospital mortality (OR: 5.95; 95% CI: 3.25–10.90). AW was also linked to 40% higher cost and 85% longer LOS. Conclusion. Both AA and AW are associated with adverse outcomes in patients undergoing spinal fusion surgery with more pronounced risks for AW. Aggressive management in perioperative period is required to improve outcomes in these patients. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion

xloma.fota13 shared this article with you from Inoreader The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion Via Spine - Featured Articles - Featured Articles Study Design. Retrospective cohort. Objective. To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Summary of Background. Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patient-reported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery. Methods. Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated. Results. A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively. Conclusion. Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0–4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Validation of the Yoruba Version of the Pain Self-Efficacy Questionnaire in Patients with Chronic Low Back Pain

xloma.fota13 shared this article with you from Inoreader Validation of the Yoruba Version of the Pain Self-Efficacy Questionnaire in Patients with Chronic Low Back Pain Via Spine - Featured Articles - Featured Articles Study Design. Cultural adaptation and psychometric analysis. Objective. This study determined the test–retest reliability, acceptability, internal consistency, divergent validity of the Yoruba pain self-efficacy questionnaire (PSEQ-Y). It also examined the ceiling and floor effects and the small detectable change (SDC) of the PSEQ-Y among patients with chronic low back pain (LBP). Summary of Background Data. There are various indigenous language translations of the PSEQ and none adapted to African language. However, translations of the PSEQ into Nigerian languages are not readily available. Methods. The validity testing phase of the study involved 131 patients with LBP, while 83 patients with LBP took part in the reliability phase. Following the Beaton recommendation for cultural adaptation of instruments, the PSEQ was adapted into the Yoruba language. The psychometric properties of the PSEQ-Y determined comprised: internal consistency, divergent validity, test–retest reliability, and SDC. Results. The mean age of the participants was 52.96 ± 17.3 years. The PSEQ-Y did not correlate with the Yoruba version of Visual Analogue Scale (VAS-Y) scores (r = –0.05; P = 0.59). The values for the internal consistency and the test–retest reliability of the PSEQ-Y were 0.79 and 0.86, with the 95% confidence interval of the test–retest reliability ranging between 0.82 and 0.90. The standard error of measurement (SEM) and the SDC of the PSEQ-Y were 1.2 and 3.3, respectively. The PSEQ-Y had no floor or ceiling effect, as none of the respondents scored either the minimal or maximal scores. Conclusion. This is the first study in Nigeria to culturally adapt PSEQ. The PSEQ-Y showed adequate psychometric properties similar to existing versions. Therefore, the tool can be used to assess pain self-efficacy in clinical and research settings and help to improve the health outcomes of patients chronic LBP. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts

xloma.fota13 shared this article with you from Inoreader Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts Via Spine - Featured Articles - Featured Articles Study Design. Survey study. Objective. Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices. Summary of Background Data. Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes. Methods. A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure. Results. We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis

xloma.fota13 shared this article with you from Inoreader Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis Via Spine - Featured Articles - Featured Articles Study Design. A systematic review and single-arm meta-analysis of randomized clinical trials. Objective. The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). Summary of Background Data. There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. Methods. On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. Results. The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted. Level of Evidence: 1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure: Case Report and Literature Review

xloma.fota13 shared this article with you from Inoreader Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure: Case Report and Literature Review Via Spine - Featured Articles - Featured Articles Study Design. Case-report and literature review. Objective. To depict main features of a potentially deleterious postoperative spinal fixation complication. Summary of Background Data. Tisular deposit of metal particles from prosthetic systems—metallosis—is an uncommon complication of spinal fixation surgery. Manifestations as chronic postoperative pain, instrumentation failure, infection, or neurological impairment can be developed, but metallosis often appears as an unexpected intraoperative finding. Methods. A 70-year-old female underwent several spinal fixation procedures due to progressive degenerative adult scoliosis, who developed instrumentation failure. Unexpected metallosis was evidenced extensively surrounding the dislodged construct due to vertebral osteolysis. Instrumentation replacement and debridement of metallotic tissue was performed. We also conduct a literature review for the terms "spinal metallosis" and "spinal corrosion" on the PubMed/MEDLINE database. Previous publications depicting black/dark staining, discoloration and/or fibrotic tissue, as well as histopathological metal particle deposits, or merely metallosis, were reviewed. Articles reporting individual cases or case-series/cohorts with patient-discriminated findings were included. Results. The histopathological analysis of our patient revealed dense fibroconnective tissue with black metallic pigment associated. She evolved with great pain relief in the immediately postoperative period. The patient achieved pain-free standing with significant pharmacotherapy reduction and independent ambulation. The literature search retrieved 26 articles for "spinal metallosis" and 116 for "spinal corrosion"; 16 articles met selection criteria. Approximately 60% of the reported cases accounted for patients younger than 30 years old, mainly related to expandable fixation system (65%) for idiopathic scoliosis. Usually, the symptoms were correlated with abnormal radiological findings: instrumentation breakage, dislodgement, loosening, expandable systems fracture. All the reviewed patients evolved free of pain and neurologically recovered. Conclusion. Instrumentation removal and metallosis debridement seems to be useful for symptomatic patients, but remains controversial on fixed asymptomatic patients. If solid fusion has not been achieved, extension, and reinforcement of the failed fixation could be required. Level of Evidence: 4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis

xloma.fota13 shared this article with you from Inoreader Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis Via Spine - Featured Articles - Featured Articles Study Design. Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial. Objective. The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis. Summary of Background Data. Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis. Methods. This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups. Results. Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis. Conclusion. While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes. Level of Evidence: 3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis

xloma.fota13 shared this article with you from Inoreader Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis Via Spine - Featured Articles - Featured Articles Study Design. Retrospective cohort. Objective. The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day all-cause readmission in patients undergoing single-level lumbar fusions. Summary of Background Data. Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. Methods. MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day all-cause readmission. Results. The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

In-hospital Course and Complications of Laminectomy Alone Versus Laminectomy Plus Instrumented Posterolateral Fusion for Lumbar Degenerative Spondylolisthesis: A Retrospective Analysis of 1804 Patients from the NSQIP Database

xloma.fota13 shared this article with you from Inoreader In-hospital Course and Complications of Laminectomy Alone Versus Laminectomy Plus Instrumented Posterolateral Fusion for Lumbar Degenerative Spondylolisthesis: A Retrospective Analysis of 1804 Patients from the NSQIP Database Via Spine - Featured Articles - Featured Articles Study Design. Retrospective analysis of data from the National Surgical Quality Improvement Program (NSQIP). Objective. We sought to compare the short-term outcomes of laminectomy with/without fusion for single-level lumbar degenerative spondylolisthesis (DS). Summary of Background Data. Lumbar DS is a common cause of low back and radicular pain. Controversy remains over the safety and efficacy of fusion in addition to standard decompressive surgery. Methods. Patients with lumbar DS who underwent laminectomy alone or laminectomy plus posterolateral fusion at a single level were identified from the 2012–2017 NSQIP database. Outcomes included 30-day mortality, major complication, reoperation, readmission, as well as operative duration, need for blood transfusion, length of stay (LOS), and discharge destination. Outcomes were compared between treatment groups by multivariable regression, adjusting for age, sex, and comorbidities (modified Frailty Index). Effect sizes were reported by adjusted odds ratio (aOR) or mean difference (aMD). Results. The study cohort consisted of 1804 patients; of these, 802 underwent laminectomy alone and 1002 laminectomy plus fusion. On both unadjusted and adjusted analyses, there was no difference in 30-day mortality, major complications, reoperation, or readmission. However, laminectomy plus fusion was associated with longer operative time (170.0 vs. 152.7 minutes; aMD 16.00 minutes, P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.