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[PMID]:29424998
[Au] Autor:Khramtsov PI; Kurgansky AM; Barsukova NK; Sedova AC; Sotnikova EN
[Ti] Título:[Estimation of the influence of the design of school backpacks to posture regulation in children with different posture conditions].
[So] Source:Gig Sanit;95(7):652-5, 2016.
[Is] ISSN:0016-9900
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:There was performed the study of the characteristics of the regulation of vertical posture in 42 children of 8-10 years old using school bags of different designs. According to medical examination 25 children have normal posture and 17 children had kyphotic one. The stability of the posture was estimated according to the average variance and the average velocity of the total center of gravity of the body, the area of the ellipse, and the quality of the equilibrium function with computer stabilography. Three models of school bags were used - with traditional, ergonomic and orthopedic back support. Vertical posture stability for children with impaired posture without school bag and when used with traditional and ergonomic back were significantly lower in comparison with children with normal posture. When the orthopedic back was used the stability impairment of the vertical posture in children with kyphotic posture was not observed. It is concluded that for the prevention of spinal deformity for students with kyphotic posture orthopedic school bags should be used.
[Mh] Termos MeSH primário: Curvaturas da Coluna Vertebral
[Mh] Termos MeSH secundário: Criança
Desenvolvimento Infantil
Vestuário/efeitos adversos
Vestuário/normas
Feminino
Seres Humanos
Masculino
Teste de Materiais/métodos
Fatores de Risco
Serviços de Saúde Escolar/normas
Serviços de Saúde Escolar/estatística & dados numéricos
Curvaturas da Coluna Vertebral/epidemiologia
Curvaturas da Coluna Vertebral/prevenção & controle
Suporte de Carga/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180210
[St] Status:MEDLINE


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[PMID]:29308864
[Au] Autor:Jandric SD
[Ti] Título:Differences in postural disturbances between female adolescents handball players and nontraining peers.
[So] Source:Vojnosanit Pregl;73(4):337-42, 2016 Apr.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: Physical activity and sport can influence the extent of the presence of the postural disturbances in children. The aim of this study was to investigate the occurrence of differences in the postural disturbances in female adolescents in relation to team handball training. Methods: This investigation involved 150 female adolescents with the average age of 13.4 ± 1.5 years divided into two groups (50 adolescents trained handball and 100 did non train it). Results: The study determined a statistically significant difference in the total number of postural disturbances between the two groups of adolescents (p < 0.001). The presence of the flat foot was statistically significantly higher in untrained adolescents (p < 0.001), but the presence of the scoliosis, kyphosis, lordosis, and pes varus was not found (p > 0.05). Conclusion: Handball adolescents players have less postural disturbances than untrained adolescents. Flat foot is significantly less frequent in female adolescents handball players than in untrained ones. Findings obtained in this investigation can help us in planning continuous prevention, observation and care for untrained and trained team handball female adolescents with postural disturbances.
[Mh] Termos MeSH primário: Pé Chato/epidemiologia
Condicionamento Físico Humano/fisiologia
Postura/fisiologia
Curvaturas da Coluna Vertebral/epidemiologia
Esportes/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.2298/VSP140507020J


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[PMID]:28976431
[Au] Autor:Yilgor C; Sogunmez N; Boissiere L; Yavuz Y; Obeid I; Kleinstück F; Pérez-Grueso FJS; Acaroglu E; Haddad S; Mannion AF; Pellise F; Alanay A; European Spine Study Group (ESSG)
[Ad] Endereço:1Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey 2Spine Research Unit, Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul, Turkey 3Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France 4Department of Biostatistics, Ankara University, Ankara, Turkey 5Spine Center Division, Department of Orthopedics and Neurosurgery (F.K.), and Spine Center Division, Department of Research and Development (A.F.M.), Schulthess Klinik, Zurich, Switzerland 6Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain 7Ankara ARTES Spine Center, Ankara, Turkey 8Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain.
[Ti] Título:Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery.
[So] Source:J Bone Joint Surg Am;99(19):1661-1672, 2017 Oct 04.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The restoration of normal sagittal alignment is a critical goal in adult spinal deformity surgery to achieve favorable outcomes and prevent mechanical complications. Schwab sagittal modifiers have been accepted as targets for appropriate alignment, but addressing these targets does not always prevent high mechanical complication or revision rates. This may be because the linear absolute numerical parameters do not cover the whole pelvic incidence spectrum and the distribution of lordosis, pelvic anteversion, and negative malalignment are not considered as potential causes of failure. The aim of the present study was to develop and validate a score based on pelvic-incidence-based proportional parameters to better predict mechanical complications. METHODS: Two hundred and twenty-two patients (168 women and 54 men) followed for ≥2 years after posterior fusion at ≥4 levels were included in the study. The mean age (and standard deviation) was 52.2 ± 19.3 years (range, 18 to 84 years), and the mean duration of follow-up was 28.8 ± 8.2 months (range, 24 to 62 months). The global alignment and proportion (GAP) score was developed and validated in groups of patients randomly assigned to derivation (n = 148, 66.7%) and validation (n = 74, 33.3%) cohorts. GAP score parameters were relative pelvic version (the measured minus the ideal sacral slope), relative lumbar lordosis (the measured minus the ideal lumbar lordosis), lordosis distribution index (the L4-S1 lordosis divided by the L1-S1 lordosis multiplied by 100), relative spinopelvic alignment (the measured minus the ideal global tilt), and an age factor. Proximal and distal junctional kyphosis and/or failure, rod breakage, and other implant-related complications were considered mechanical complications. The predictive accuracy of the GAP score was analyzed using receiver operating characteristic (ROC) analyses. Associations between GAP categories and mechanical complications and revisions were analyzed using Cochran-Armitage tests. RESULTS: In the validation cohort, 32 patients (43%) experienced mechanical complications and 17 (23%) underwent mechanical revision. The area under curve for the GAP score predicting mechanical complications was 0.92 (standard error [SE] = 0.034, p < 0.001, 95% [confidence interval [CI] = 0.85 to 0.98). Postoperatively, patients with a proportioned spinopelvic state according to the GAP score had a mechanical complication rate of 6% while those with a moderately or severely disproportioned spinopelvic state had rates of 47% and 95%, respectively. CONCLUSIONS: The GAP score is a new pelvic-incidence-based proportional method of analyzing the sagittal plane that predicts mechanical complications in patients undergoing surgery for adult spinal deformity. Setting surgical goals according to the GAP score may decrease the prevalence of mechanical complications.
[Mh] Termos MeSH primário: Complicações Pós-Operatórias/epidemiologia
Curvaturas da Coluna Vertebral/cirurgia
Fusão Vertebral/efeitos adversos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/diagnóstico por imagem
Reprodutibilidade dos Testes
Estudos Retrospectivos
Curvaturas da Coluna Vertebral/diagnóstico por imagem
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01594


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[PMID]:28914116
[Au] Autor:de Kleuver M; Faraj SSA; Holewijn RM; Germscheid NM; Adobor RD; Andersen M; Tropp H; Dahl B; Keskinen H; Olai A; Polly DW; van Hooff ML; Haanstra TM
[Ad] Endereço:a Department of Orthopedic Surgery , Radboud University Medical Center , Nijmegen , the Netherlands.
[Ti] Título:Defining a core outcome set for adolescent and young adult patients with a spinal deformity.
[So] Source:Acta Orthop;88(6):612-618, 2017 Dec.
[Is] ISSN:1745-3682
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose - Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods - From August 2015 to September 2016, 7 representatives (panelists) of the national spinal surgery registries from each of the NSDS countries participated in a modified Delphi study. With a systematic literature review as a basis and the International Classification of Functioning, Disability and Health framework as guidance, 4 consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results - Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction with cosmetic result of surgery", "pain interference", physical functioning", "health-related quality of life", "recreation and leisure", "pulmonary fatigue", "change in deformity", "self-image", "pain intensity", "physical function", "complications", and "re-operation". Panelists agreed that the SRS-22r, EQ-5D, and a pulmonary fatigue questionnaire (yet to be developed) are the most appropriate set of patient-reported measurement instruments that cover these outcome domains. Interpretation - We have identified a COS for a large subgroup of spinal deformity patients for implementation and validation in the NSDS countries. This is the first study to further develop a COS in a global perspective.
[Mh] Termos MeSH primário: Consenso
Determinação de Ponto Final/métodos
Procedimentos Ortopédicos/métodos
Satisfação do Paciente
Qualidade de Vida
Curvaturas da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Técnica Delfos
Feminino
Seres Humanos
Masculino
Estudos Retrospectivos
Países Escandinavos e Nórdicos
Curvaturas da Coluna Vertebral/psicologia
Inquéritos e Questionários
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1080/17453674.2017.1371371


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[PMID]:28862571
[Au] Autor:Guan J; Cole CD; Schmidt MH; Dailey AT
[Ad] Endereço:Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and.
[Ti] Título:Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery.
[So] Source:J Neurosurg Spine;27(5):528-533, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Blood loss during surgery for thoracolumbar scoliosis often requires blood product transfusion. Rotational thromboelastometry (ROTEM) has enabled the more targeted treatment of coagulopathy, but its use in deformity surgery has received limited study. The authors investigated whether the use of ROTEM reduces transfusion requirements in this case-control study of thoracolumbar deformity surgery. METHODS Data were prospectively collected on all patients who received ROTEM-guided blood product management during long-segment (≥ 7 levels) posterior thoracolumbar fusion procedures at a single institution from April 2015 to February 2016. Patients were matched with a group of historical controls who did not receive ROTEM-guided therapy according to age, fusion segments, number of osteotomies, and number of interbody fusion levels. Demographic, intraoperative, and postoperative transfusion requirements were collected on all patients. Univariate analysis of ROTEM status and multiple linear regression analysis of the factors associated with total in-hospital transfusion volume were performed, with p < 0.05 considered to indicate statistical significance. RESULTS Fifteen patients who received ROTEM-guided therapy were identified and matched with 15 non-ROTEM controls. The mean number of fusion levels was 11 among all patients, with no significant differences between groups in terms of fusion levels, osteotomy levels, interbody fusion levels, or other demographic factors. Patients in the non-ROTEM group required significantly more total blood products during their hospitalization than patients in the ROTEM group (8.5 ± 4.2 units vs 3.71 ± 2.8 units; p = 0.001). Multiple linear regression analysis showed that the use of ROTEM (p = 0.016) and a lower number of fused levels (p = 0.022) were associated with lower in-hospital transfusion volumes. CONCLUSIONS ROTEM use during thoracolumbar deformity correction is associated with lower transfusion requirements. Further investigation will better define the role of ROTEM in transfusion during deformity surgery.
[Mh] Termos MeSH primário: Vértebras Lombares/cirurgia
Monitorização Intraoperatória
Curvaturas da Coluna Vertebral/cirurgia
Vértebras Torácicas/cirurgia
Tromboelastografia
[Mh] Termos MeSH secundário: Idoso
Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Sangue
Estudos de Casos e Controles
Feminino
Seres Humanos
Modelos Lineares
Masculino
Meia-Idade
Monitorização Intraoperatória/métodos
Osteotomia
Estudos Prospectivos
Estudos Retrospectivos
Fusão Vertebral
Tromboelastografia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.SPINE1788


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[PMID]:28820363
[Au] Autor:Jain A; Hassanzadeh H; Puvanesarajah V; Klineberg EO; Sciubba DM; Kelly MP; Hamilton DK; Lafage V; Buckland AJ; Passias PG; Protopsaltis TS; Lafage R; Smith JS; Shaffrey CI; Kebaish KM; International Spine Study Group
[Ad] Endereço:Departments of 1 Orthopaedic Surgery and.
[Ti] Título:Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients.
[So] Source:J Neurosurg Spine;27(5):534-539, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.
[Mh] Termos MeSH primário: Curvaturas da Coluna Vertebral/mortalidade
Curvaturas da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Idoso
Bases de Dados Factuais
Feminino
Seguimentos
Seres Humanos
Incidência
Masculino
Medicare
Período Perioperatório
Complicações Pós-Operatórias/mortalidade
Estudos Prospectivos
Curvaturas da Coluna Vertebral/diagnóstico por imagem
Fusão Vertebral
Cirurgiões
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.3171/2017.3.SPINE161011


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[PMID]:28799837
[Au] Autor:Lee CH; Chung CK; Jang JS; Kim SM; Chin DK; Lee JK; Yoon SH; Hong JT; Ha Y; Kim CH; Hyun SJ
[Ad] Endereço:Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang.
[Ti] Título:Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis.
[So] Source:J Neurosurg Spine;27(5):540-551, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs. RESULTS Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48-4.82]) but not for ODI values (18.11 [95% CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60° [95% CI -44.19° to -33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°-37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27-94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°-37.23°]) remained outside their normal ranges. Meta-regression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively. CONCLUSIONS Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.
[Mh] Termos MeSH primário: Curvaturas da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE
[do] DOI:10.3171/2017.3.SPINE161134


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[PMID]:28665245
[Au] Autor:Adogwa O; Elsamadicy AA; Sergesketter A; Vuong VD; Mehta AI; Vasquez RA; Cheng J; Bagley CA; Karikari IO
[Ad] Endereço:Department of Neurosurgery, Rush University Medical Center.
[Ti] Título:Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases.
[So] Source:J Neurosurg Spine;27(3):328-334, 2017 Sep.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Wound infections following spinal surgery for deformity place a high toll on patients, providers, and the health care system. The prophylactic application of intraoperative vancomycin powder has been shown to lower the infection risk after thoracolumbar decompression and fusion for deformity correction. The purpose of this study was to assess the microbiological patterns of postoperative surgical site infections (SSIs) after prophylactic use of vancomycin powder in adult patients undergoing spinal deformity surgery. METHODS All cases involving adult patients who underwent spinal deformity reconstruction at Duke University Medical Center between 2011 and 2013 with a minimum of 3 months of clinical follow-up were retrospectively reviewed. In all cases included in the study, crystalline vancomycin powder was applied to the surgical bed for infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiological data for each case were gathered by direct medical record review. RESULTS A total of 1200 consecutive spine operations were performed for deformity between 2011 and 2013. Review of the associated records demonstrated 34 cases of SSI, yielding an SSI rate of 2.83%. The patients' mean age (± SD) was 62.08 ± 14.76 years. The patients' mean body mass index was 30.86 ± 7.15 kg/m , and 29.41% had a history of diabetes. The average dose of vancomycin powder was 1.41 ± 2.77 g (range 1-7 g). Subfascial drains were placed in 88% of patients. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50%. In 74% of the SSIs cultures were positive, with about half the organisms being gram negative, such as Citrobacter freundii, Proteus mirabilis, Morganella morgani, and Pseudomonas aeruginosa. There were no adverse clinical outcomes related to the local application of vancomycin. CONCLUSIONS Our study suggests that in the setting of prophylactic vancomycin powder use, the preponderance of SSIs are caused by gram-negative organisms or are polymicrobial. Further randomized control trials of prophylactic adjunctive measures are warranted to help guide the choice of empirical antibiotic therapy while awaiting culture data.
[Mh] Termos MeSH primário: Antibacterianos/administração & dosagem
Antibioticoprofilaxia
Coluna Vertebral/cirurgia
Infecção da Ferida Cirúrgica/microbiologia
Infecção da Ferida Cirúrgica/prevenção & controle
Vancomicina/administração & dosagem
[Mh] Termos MeSH secundário: Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Pós
Estudos Retrospectivos
Curvaturas da Coluna Vertebral/cirurgia
Infecção da Ferida Cirúrgica/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Powders); 6Q205EH1VU (Vancomycin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170701
[St] Status:MEDLINE
[do] DOI:10.3171/2017.2.SPINE161310


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[PMID]:28598295
[Au] Autor:Pourtaheri S; Sharma A; Savage J; Kalfas I; Mroz TE; Benzel E; Steinmetz MP
[Ad] Endereço:Department of Orthopedic Surgery, UCLA Health, Los Angeles, California.
[Ti] Título:Pelvic retroversion: a compensatory mechanism for lumbar stenosis.
[So] Source:J Neurosurg Spine;27(2):137-144, 2017 Aug.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE The flexed posture of the proximal (L1-3) or distal (L4-S1) lumbar spine increases the diameter of the spinal canal and neuroforamina and can relieve symptoms of neurogenic claudication. Distal lumbar flexion can result in pelvic retroversion; therefore, in cases of flexible sagittal imbalance, pelvic retroversion may be compensatory for lumbar stenosis and not solely compensatory for the sagittal imbalance as previously thought. The authors investigate underlying causes for pelvic retroversion in patients with flexible sagittal imbalance. METHODS One hundred thirty-eight patients with sagittal imbalance who underwent a total of 148 fusion procedures of the thoracolumbar spine were identified from a prospective clinical database. Radiographic parameters were obtained from images preoperatively, intraoperatively, and at 6-month and 2-year follow-up. A cohort of 24 patients with flexible sagittal imbalance was identified and individually matched with a control cohort of 23 patients with fixed deformities. Flexible deformities were defined as a 10° change in lumbar lordosis between weight-bearing and non-weight-bearing images. Pelvic retroversion was quantified as the ratio of pelvic tilt (PT) to pelvic incidence (PI). RESULTS The average difference between lumbar lordosis on supine MR images and standing radiographs was 15° in the flexible cohort. Sixty-eight percent of the patients in the flexible cohort were diagnosed preoperatively with lumbar stenosis compared with only 22% in the fixed sagittal imbalance cohort (p = 0.0032). There was no difference between the flexible and fixed cohorts with regard to C-2 sagittal vertical axis (SVA) (p = 0.95) or C-7 SVA (p = 0.43). When assessing for postural compensation by pelvic retroversion in the stenotic patients and nonstenotic patients, the PT/PI ratio was found to be significantly greater in the patients with stenosis (p = 0.019). CONCLUSIONS For flexible sagittal imbalance, preoperative attention should be given to the root cause of the sagittal misalignment, which could be compensation for lumbar stenosis. Pelvic retroversion can be compensatory for both the lumbar stenosis as well as for sagittal imbalance.
[Mh] Termos MeSH primário: Vértebras Lombares/cirurgia
Pelve
Postura
Curvaturas da Coluna Vertebral/diagnóstico por imagem
Estenose Espinal/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Feminino
Seguimentos
Seres Humanos
Vértebras Lombares/diagnóstico por imagem
Masculino
Meia-Idade
Pelve/diagnóstico por imagem
Complicações Pós-Operatórias
Estudos Prospectivos
Estudos Retrospectivos
Curvaturas da Coluna Vertebral/cirurgia
Fusão Vertebral
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170610
[St] Status:MEDLINE
[do] DOI:10.3171/2017.2.SPINE16963


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[PMID]:28574333
[Au] Autor:Elsamadicy AA; Adogwa O; Lydon E; Sergesketter A; Kaakati R; Mehta AI; Vasquez RA; Cheng J; Bagley CA; Karikari IO
[Ad] Endereço:Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
[Ti] Título:Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.
[So] Source:J Neurosurg Spine;27(2):209-214, 2017 Aug.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In total, 66 patients (7.15%) had an episode of postoperative delirium, with depressed patients experiencing approximately a 2-fold higher rate of delirium (10.59% vs 5.84%). In a multivariate logistic regression analysis, depression was an independent predictor of postoperative delirium after spine surgery in spinal deformity patients (p = 0.01). CONCLUSIONS The results of this study suggest that depression is an independent risk factor for postoperative delirium after elective spine surgery. Further studies are necessary to understand the effects of affective disorders on postoperative delirium, in hopes to better identify patients at risk.
[Mh] Termos MeSH primário: Delírio/diagnóstico
Depressão/complicações
Complicações Pós-Operatórias/diagnóstico
Curvaturas da Coluna Vertebral/psicologia
Curvaturas da Coluna Vertebral/cirurgia
Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Fatores Etários
Comorbidade
Descompressão Cirúrgica
Delírio/epidemiologia
Delírio/etiologia
Depressão/diagnóstico
Depressão/epidemiologia
Procedimentos Cirúrgicos Eletivos
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Duração da Cirurgia
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/psicologia
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Curvaturas da Coluna Vertebral/complicações
Curvaturas da Coluna Vertebral/epidemiologia
Fusão Vertebral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.3171/2017.4.SPINE161012



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