The spine journal : official journal of the North American Spine Society
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The Patient-Reported Outcomes Information System (PROMIS) instruments are an important advancement in the use of PROs, but need to be evaluated with longitudinal data to determine whether they are responsive to change in specific clinical populations. ⋯ This study demonstrates strong responsiveness of the PROMIS PF and PROMIS PI in a spine clinic population.
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Rod fracture (RF) has a negative impact on the surgical outcome of patients with ankylosing spondylitis (AS) after lumbar pedicle subtraction osteotomy (PSO). However, there is a paucity of published studies analyzing the risk factors for RF in PSO-treated patients with AS with thoracolumbar kyphosis. ⋯ In patients with AS after PSO for thoracolumbar kyphosis with solid fusion at the PSO level, the incidence of RF was 8.9%. Rod diameter was identified as a risk factor for RF. Furthermore, the RCA was identified as an independent risk factor for RF. In contrast, adequate ossification of the ALL around the PSO level at the final follow-up visit was identified as an independent protective factor for RF.
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Increasing evidence suggests transplanting viable cells into the degenerating intervertebral disc (IVD) may be effective in treating disc degeneration and back pain. Clinical studies utilizing autologous or allogeneic mesenchymal stem cells to treat patients with back pain have reported some encouraging results. Animal studies have shown that cells injected into the disc can survive for months and have regenerative effects. Studies to determine the advantages and disadvantages of cell types and sources for therapy are needed. ⋯ This study showed that cell transplantation with nHDF into degenerated IVDs can significantly increase markers of disc regeneration (disc height, collagen type I and II gene expression, and proteoglycan contents). Transplantation with RDFs showed similar regenerative trends, but these trends were not significant. This study also showed that the human cells transplanted into the rabbit discs did not induce a higher immune response than the rabbit cells. These results support that the IVD is immune privileged and would tolerate allogeneic or xenogeneic grafts.
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As increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome that has been closely linked to poor outcomes, and short-form screening may be a helpful tool for preoperative identification of at-risk patients. ⋯ This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery.
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Health-related quality of life (HRQOL) parameters have been shown to be reliable and valid in patients with adult spinal deformity (ASD). Minimum clinically important difference (MCID) has become increasingly important to clinicians in evaluating patients with a threshold of improvement that is clinically relevant. ⋯ This study has demonstrated that MCID calculations for the HRQOL scales in ASD using LCA yield values comparable to other studies that had used different methodologies. The most important finding was the significantly different MCIDs for COMI, ODI, SF-36 PCS and SRS-22 in the surgically and nonsurgically treated cohorts. This finding suggests that a universal MCID value, inherent to a specific HRQOL for an entire cohort of ASD may not exist. Use of different MCIDs for surgical and nonsurgical patients may be warranted.