The spine journal : official journal of the North American Spine Society
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Severely obese patients with operative spinal pathology present a challenge to the spine surgeon, given the increased complication risk. ⋯ Bariatric surgery before elective posterior lumbar fusion mitigates risk of medical complications and infection. However, these patients still have increased risk of infection, revision surgery, and readmission compared with patients with normal BMI. Surgeons might consider referral for BS for the severely obese patient before undergoing spine surgery.
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Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait. ⋯ Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols.
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Endothelin-1 (ET-1) is an inflammatory mediator associated with cartilage end plate (CEP) degeneration in the intervertebral disc (IVD). SOX9 is downregulated during CEP degeneration, along with its targets, collagen II and aggrecan. Wnt/β-catenin signaling is associated with CEP degeneration and a downstream target of SOX9; however, the precise mechanism of CEP degeneration and the role of ET-1 are largely unknown. ⋯ Endothelin-1 can reduce levels of collagen II, aggrecan, and SOX9 in CECs through activation of the Wnt/β-catenin signaling pathway, whereas BQ-123 attenuates these negative effects, highlighting a new molecular mechanism with potential for exploitation for treatment of CEP degeneration.
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Postoperative urinary retention (POUR) is a very common postoperative complication of all surgeries (5%-70%) that may lead to complications such as urinary tract infection (UTI), bladder overdistension, autonomic dysregulation, and increased postoperative length of stay (LOS). Within the field of spine surgery, the reported incidence rate of POUR is highly variable (5.6%-38%). Lack of clear stratification of surgical level, spinal pathology, and inadequate sample size are major limitations of available studies concerning POUR following spine surgery, which may lead to inconsistency in the incidence of POUR and the ability to model its occurrence and consequences. ⋯ Overall, POUR was a significant risk factor for the development of UTI, sepsis, increased LOS, discharge to a SNF, and readmission within 90 days. Surgeons and anesthesiologists should take preventative measures against POUR in individuals with increased age, BPH, AKI, and UTI within 90 days before surgery, as these factors were found to significantly increase the risk of POUR.