Vascular compromise due to arterial injury is a rare but serious complication of a proximal humeral fracture. The aims of this study were to report its incidence in a large urban population, and to identify clinical and radiological factors which are associated with this complication. We also evaluated the results of the use of our protocol for the management of these injuries. A total of 3,497 adult patients with a proximal humeral fracture were managed between January 2015 and December 2022 in a single tertiary trauma centre. Their mean age was 66.7 years (18 to 103) and 2,510 (72%) were female. We compared the demographic data, clinical features, and configuration of those whose fracture was complicated by vascular compromise with those of the remaining patients. The incidence of vascular compromise was calculated from national population data, and predictive factors for its occurrence were investigated using univariate analysis.Aims
Methods
The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.Aims
Methods
Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted. As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three months. The intended sample size was 60 patients.Aims
Methods
Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes.Aims
Methods
Aims. To compare the efficacy of decompression alone (DA) with i) decompression and fusion (DF) and ii) interspinous process device (IPD) in the treatment of lumbar stenosis with degenerative spondylolisthesis. Outcomes of interest were both patient-reported measures of postoperative pain and function, as well as the perioperative measures of blood loss, operation duration, hospital stay, and reoperation. Methods. Data were obtained from electronic searches of five online databases. Included studies were limited to randomised-controlled trials (RCTs) which compared DA with DF or IPD using patient-reported outcomes such as the Oswestry Disability Index (ODI) and Zurich
The rate of arterial injury in trauma patients with pelvic ring fractures has been cited as high as 15%. Addressing this source of hemorrhage is essential in the management of these patients as mortality rates are reported as 50%. Percutaneous techniques to control arterial bleeding, such as embolization and REBOA, are being employed with increasing frequency due to their assumed lower morbidity and invasiveness than open exploration or cross clamping of the aorta. There are promising results with regards to the mortality benefits of angioembolization. However, there are concerns with regards to morbidity associated with embolization of the internal iliac vessels and its branches including surgical wound infection, gluteal muscle necrosis, nerve injury, bowel infarction, and thigh / buttock
Purpose and background. To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic
Abstract. Objective. Flexible stabilisation has been utilised to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any non-fusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean five-year outcomes of patients treated with the TOPS (Total Posterior Spine System) facet replacement system in the surgical management of lumbar spinal stenosis and degenerative spondylolisthesis. Methods. Ten patients (2 males, 8 females, mean age 59.6) were enrolled into a non-randomised prospective clinical study. Patients were evaluated with standing AP, lateral, flexion and extension radiographs and MRI scans, back and leg pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI), Zurich
To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine. A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion.Aims
Methods
Aims. Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Materials and Methods. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological
The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level. This was a retrospective study of 235 consecutive patients who had undergone decompression-only surgery for lumbar spinal stenosis and had a minimum five-year follow-up. There were 106 female patients (45.1%) and 129 male patients (54.9%), with a mean age at surgery of 66.8 years (Aims
Patients and Methods
Purpose. Patients may present with concurrent symptomatic hip and spine problems, with surgical treatment indicated for both. Controversy exists over which procedure, total hip arthroplasty (THA) or lumbar spine procedure, should be performed first, and does the surgeon's area of expertise influence the choice. Materials & Methods. Clinical scenarios were devised for 5 fictional patients with both symptomatic hip and lumbar spine disorders for which surgical treatment was indicated. An email with survey link was sent to 110 clinical members of the Hip Society and 101 experienced spine surgeons in the USA requesting responses to: which procedure should be performed first, and the rationale for the decision with comments. The clinical scenarios were painful hip osteoarthritis and (1) lumbar spinal stenosis with neurologic
Patients may present with concurrent symptomatic hip and spine problems, with surgical treatment indicated for both. Controversy exists over which procedure, total hip arthroplasty (THA) or lumbar spine procedure, should be performed first. Clinical scenarios were devised for 5 fictional patients with both symptomatic hip and lumbar spine disorders for which surgical treatment was indicated. An email with survey link was sent to 110 clinical members of the NA Hip Society requesting responses to: which procedure should be performed first; the rationale for the decision with comments, and the type of THA prosthesis if “THA first” was chosen. The clinical scenarios were painful hip osteoarthritis and (1) lumbar spinal stenosis with neurologic
Introduction. Limited physical activity (PA) is one indication for orthopaedic intervention and restoration of PA a treatment goal. However, the objective assessment of PA is not routinely performed and in particular the effect of spinal pathology on PA is hardly known. It is the purpose of this study using wearable accelerometers to measure if, by how much and in what manner spinal stenosis affects PA compared to age-matched healthy controls. Patients & Methods. Nine patients (m/f= 5/4, avg. age: 67.4 ±7.7 years, avg. BMI: 29.2 ±3.5) diagnosed with spinal stenosis but without decompressive surgery or other musculoskeletal complaints were measured. These patients were compared to 28 age-matched healthy controls (m/f= 17/11, avg. age: 67.4 ±7.6 years, avg. BMI: 25.3±2.9). PA was measured using a wearable accelerometer (GCDC X8M-3) worn during waking hours on the lateral side of the right leg for 4 consecutive days. Data was analyzed using previously validated activity classification algorithms in MATLAB to identify the type, duration and event counts of postures or PA like standing, sitting, walking or cycling. In addition, VAS pain and OSWESTRY scores were taken. Groups were compared using the t-test or Mann-Whitney U-test where applicable. Correlations between PA and clinical scores were tested using Pearson”s r. Results. Spinal stenosis patients showed much lower PA than healthy controls regarding all parameters like e.g. daily step count (2946 vs 8039, −63%, p<0.01) or the relative daily time-on-feet (%) (8.6% vs 28.3%, −70%, p<0.01) which is matched with increased sitting durations (80.3% vs 58.8%, p<0.01). Also qualitative parameters such as walking cadence was reduced in stenosis patients (83.7 vs 97.8 steps/min). With stenosis no patient ever walked >1000 steps without interruption. Also the number of walking bouts between 250–1000 steps was 4.5 times lower than in healthy controls (p<0.01). When the relative distribution of walking bout length was calculated, it became visible that stenosis patients showed more short walking bouts of 10–50 steps (p<0.05). There were no strong and significant correlations between the clinical scores and PA parameters. Discussion & Conclusions. Spinal stenosis greatly reduced physical activity to levels below WHO guidelines (e.g. <5000 steps= sedentary lifestyle) where the risk for general health (overall mortality), cardiovascular or endocrinological health is significantly increased. Activity levels are lower than reported for end-stage hip or knee osteoarthritis. Therefore, spinal stenosis patients should not only receive pain medication, but be made aware of their limited PA and its detrimental health effects, participate in activation programs, or be considered for surgical intervention. The absence of long walking bouts and the relatively more frequent short walking bouts seem indicative of intermittent
The aim of this study was to investigate the clinical and radiographic
outcomes of microendoscopic laminotomy in patients with lumbar stenosis
and concurrent degenerative spondylolisthesis (DS), and to determine
the effect of this procedure on spinal stability. A total of 304 consecutive patients with single-level lumbar
DS with concomitant stenosis underwent microendoscopic laminotomy
without fusion between January 2004 and December 2010. Patients
were divided into two groups, those with and without advanced DS
based on the degree of spondylolisthesis and dynamic instability. A
total of 242 patients met the inclusion criteria. There were 101
men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome
was assessed using the Japanese Orthopaedic Association and Roland
Morris Disability Questionnaire scores, a visual analogue score
for pain and the Short Form Health-36 score. The radiographic outcome
was assessed by measuring the slip and the disc height. The clinical
and radiographic parameters were evaluated at a mean follow-up of
4.6 years (3 to 7.5).Aims
Patients and Methods