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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (10 June 2022) | Viewed by 66738

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Special Issue Editors

Prof. Dr. Michael Akbar

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Guest Editor

MEOCLINIC, Friedrichstraße 71, 10117 Berlin, Germany
Interests: adolescent idiopathic scoliosis; scoliosis; kyphotic deformities; spine deformity; sagittal profile; spinal navigation; degenerative spine; spinal fracture; stereoradiography; cervical spine; aging spine; spondylodiscitis; spinal tumor
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Yu-Mi Ryang

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Guest Editor

Head of Department, Department of Neurosurgery, Helios Klinikum, Buch, Berlin, Germany
Interests: spinal navigation; robot-assisted spine surgery; spinal implant development; aging spine
Special Issues, Collections and Topics in MDPI journals

Dr. Wojciech Pepke

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Guest Editor

Consultant Spine Surgeon, Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany
Interests: aging spine; spine deformity; sagittal profile; adolescent idiopathic scoliosis; stereoradiography; bracing; cervical spine

Special Issue Information

Dear Colleagues,

During the past decade, spinal surgery has been subject to a multitude of technological advances and innovations, and many specialties are experiencing a change in their treatment paradigms. The aim of this Special Issue is to give the reader an overview of new and emerging technologies, critically assess their usefulness and effectiveness, and elucidate the existing quality of scientific evidence on these topics.

Special focus will be placed on recent advances in:

spinal tumor surgery, i.e., treatment of metastatic spine disease with or without spinal cord compression (carbon-fiber-reinforced PEEK implants, separation surgery, tumorablation, intraoperative radiation therapy) and treatment of malignant primary bone tumors (neoadjuvant treatment, proton therapy, surgical techniques (en bloc vs. debulking, surgery vs. radiation);
neurogenic and juvenile idiopathic scoliosis (growing rods, sublaminar bands);
TDR vs. ACDF (long-term outcome);
prevention and surgical treatment of adjacent segment disease and proximal junctional kyphosis (interspinous bands);
emerging technologies (spinal navigation 2.0, robot-assisted surgery, three-dimensional (3D) visualization, exoscope, virtual/augmented reality) and their implications;
minimally invasive surgery (MIS);
treatment of the aging spine (fast track surgery, prehabilitation);
bracing in scoliosis;
sagittal profile; and
new innovative diagnostic tools (stereoradiography).

Prof. Dr. Michael Akbar
Prof. Dr. Yu-Mi Ryang
Dr. Wojciech Pepke
Guest Editors

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Keywords

idiopathic and neuromuscular scoliosis
spinal tumor surgery
proximal junctional kyphosis
spondylodiscitis
emerging technologies (robot-assisted surgery)
minimally invasive surgery (MIS)
aging spine
sagittal profile
new materials
new innovative diagnostic tools (stereoradiography)

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The Latest Trends in Spine Surgery in Journal of Clinical Medicine (1 article)

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24 pages, 5684 KiB

Open AccessArticle

Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq^® Robotic Alignment: An Evaluation of the First 70 Screws

by Mirza Pojskić, Miriam Bopp, Christopher Nimsky, Barbara Carl and Benjamin Saβ

J. Clin. Med. 2021, 10(24), 5725; https://doi.org/10.3390/jcm10245725 - 7 Dec 2021

Cited by 14 | Viewed by 4999

Abstract

Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab’s Cirq^® surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq^® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab’s Cirq^® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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14 pages, 2087 KiB

Open AccessArticle

The Morphological Changes in Adjacent Segments Amongst Patients Receiving Anterior and Oblique Lumbar Interbody Fusion: A Retrospective Study

by Kuan-Kai Tung, Fang-Wei Hsu, Hsien-Che Ou, Kun-Hui Chen, Chien-Chou Pan, Wen-Xian Lu, Ning-Chien Chin, Cheng-Min Shih, Yun-Che Wu and Cheng-Hung Lee

J. Clin. Med. 2021, 10(23), 5533; https://doi.org/10.3390/jcm10235533 - 26 Nov 2021

Cited by 6 | Viewed by 3039

Abstract

Adjacent segment disease (ASD) is troublesome condition that has proved to be highly related to spinal malalignment after spinal surgery. Hence, we aimed to evaluate the morphological changes after anterior lumbar interbody fusion (ALIF) and oblique LIF (OLIF) to establish the differences between the two surgical methods in terms of possible ASD avoidance. Fifty patients, half of whom received ALIF while the other half received OLIF, were analyzed with image studies and functional outcomes during the pre-operative and post-operative periods, and 2 years after surgery. Image measurements obtained included spinal-pelvic parameters, index lordosis (IL), segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH) and adjacent segment disc angle (ASDA). The ADH and PDH in the adjacent segment decreased in the two groups while OLIF showed greater decrease without radiological ASD noted at 2-year follow-up. Both groups showed an increase in IL after surgery while ALIF showed greater improvement. No statistical difference was identified in functional outcomes between LIFs. We suggest that both ALIF and OLIF can restore adequate lordosis and prevent ASD after surgery. However, it should be noted that patient selection remains crucial when making any decision involving which of the two methods to use. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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11 pages, 2221 KiB

Open AccessArticle

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

by Ting-Yu Shih, Yun-Che Wu, Sheng-Chieh Tseng, Kun-Hui Chen, Chien-Chou Pan and Cheng-Hung Lee

J. Clin. Med. 2021, 10(22), 5447; https://doi.org/10.3390/jcm10225447 - 22 Nov 2021

Cited by 1 | Viewed by 2096

Abstract

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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10 pages, 2384 KiB

Open AccessArticle

Incidence and Radiological Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw Instrumentation with Rod Derotation and Direct Vertebral Rotation: A Minimum 5-Year Follow-Up Study

by Hong Jin Kim, Jae Hyuk Yang, Dong-Gune Chang, Se-Il Suk, Seung Woo Suh, Ji Su Kim, Sang-Il Kim, Kwang-Sup Song and Woojin Cho

J. Clin. Med. 2021, 10(22), 5351; https://doi.org/10.3390/jcm10225351 - 17 Nov 2021

Cited by 10 | Viewed by 2404

Abstract

Several studies have reported incidence and risk factors for the development of proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS). However, there is little information regarding long-term follow-up after pedicle screw instrumentation (PSI) with rod derotation (RD) and direct vertebral rotation (DVR). Sixty-nine AIS patients who underwent deformity correction using PSI with RD and DVR were retrospectively analyzed in two groups according to the occurrence of PJK, with a minimum five-year follow-up, including a non-PJK group (n = 62) and PJK group (n = 7). Radiological parameters were evaluated at preoperative, postoperative, and last follow-up. Incidence for PJK was 10.1% (7/69 patients), with a mean 9.4-year follow-up period. The thoracolumbar/lumbar curve (TL/L curve) was proportionally higher in the PJK group. The proximal compensatory curve was significantly lower in the PJK group than in the non-PJK group preoperatively (p = 0.027), postoperatively (p = 0.001), and at last follow-up (p = 0.041). The development of PJK was associated with the TL/L curve pattern, lower preoperative proximal compensatory curve, and over-correction of the proximal curve for PSI with RD and DVR. Therefore, careful evaluation of compensatory curves as well as of the main curve is important to prevent the development of PJK in the treatment of AIS. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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10 pages, 2123 KiB

Open AccessArticle

Comparison of Simultaneous Single-Position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation with Posterior Lumbar Interbody Fusion Using O-arm Navigated Technique for Lumbar Degenerative Diseases

by Ying Tan, Masato Tanaka, Sumeet Sonawane, Koji Uotani, Yoshiaki Oda, Yoshihiro Fujiwara, Shinya Arataki, Taro Yamauchi, Tomoyuki Takigawa and Yasuo Ito

J. Clin. Med. 2021, 10(21), 4938; https://doi.org/10.3390/jcm10214938 - 26 Oct 2021

Cited by 16 | Viewed by 2592

Abstract

Minimally invasive posterior or transforaminal lumbar interbody fusion (MI-PLIF/TLIF) are widely accepted procedures for lumbar instability due to degenerative or traumatic diseases. Oblique lateral interbody fusion (OLIF) is currently receiving considerable attention because of the reductions in damage to the back muscles and neural tissue. The aim of this study was to compare clinical and radiographic outcomes of simultaneous single-position OLIF and percutaneous pedicle screw (PPS) fixation with MI-PLIF/TLIF. This retrospective comparative study included 98 patients, comprising 63 patients with single-position OLIF (Group SO) and 35 patients with MI-PLIF/TLIF (Group P/T). Cases with more than 1 year of follow-up were included in this study. Mean follow-up was 32.9 ± 7.0 months for Group SO and 33.7 ± 7.5 months for Group P/T. Clinical and radiological evaluations were performed. Comparing Group SO to Group P/T, surgical time and blood loss were 118 versus 172 min (p < 0.01) and 139 versus 374 mL (p < 0.01), respectively. Cage height, change in disk height, and postoperative foraminal height were significantly higher in Group SO than in Group P/T. The fusion rate was 96.8% in Group SO, similar to the 94.2% in Group P/T (p = 0.985). The complication rate was 6.3% in Group SO and 14.1% in Group P/T (p = 0.191). Simultaneous single position O-arm-navigated OLIF reduces the surgical time, blood loss, and time to ambulation after surgery. Good indirect decompression can be achieved with this method. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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11 pages, 1685 KiB

Open AccessArticle

Morbidity and Mortality in Patients over 90 Years of Age Following Posterior Stabilization for Acute Traumatic Odontoid Type II Fractures: A Retrospective Study with a Mean Follow-Up of Three Years

by Mohammed Issa, Karl L. Kiening, Andreas W. Unterberg, Moritz Scherer, Alexander Younsi, Stepan Fedorko, Rod J. Oskouian, Jens R. Chapman and Basem Ishak

J. Clin. Med. 2021, 10(17), 3780; https://doi.org/10.3390/jcm10173780 - 24 Aug 2021

Cited by 6 | Viewed by 3722

Abstract

Odontoid type II fractures represent the most common cervical spine injuries in the elderly. The decision for surgical treatment in very elderly patients is still controversial. The aim of this study was to assess morbidity and mortality in patients over 90 years of age undergoing CT-guided posterior stabilization for unstable odontoid type II fractures. A total of 15 patients with an acute traumatic odontoid type II fracture who received surgical treatment for unstable odontoid type II fractures were retrospectively analyzed. Complications, morbidity, and mortality as well as length of ICU and hospital stay were determined. Clinical follow-up evaluation was based on outpatient presentation and information from family members and general practitioners. Finally, we conducted a comparison of complications rates between patients over 90 years of age and patients between 65 and 89 years old with a type II odontoid fracture after CT-guided posterior stabilization in our institution. The mean age was 91.4 years. Patients were predominately female (87%). In-hospital deaths did not occur. The average length of the hospital stay was 13.4 days and 1.9 days for the ICU. Blood transfusion was necessary in two patients (13%). Two patients (13%) developed urinary tract infection, one patient (7%) a delirium, and another epistaxis (7%). One patient (7%) developed pneumonic sepsis and fully recovered within several weeks. The mean follow-up was 36 months (range 9–72 months). Implant-related complications developed in one patient (7%). Five patients died during the follow-up period, with an average time to death of 26.6 months. Postoperative bracing was not needed in any of the patients. Posterior stabilization of unstable odontoid fractures type II using CT-guided navigation in patients over 90 years of age is a safe and effective procedure with low complications and mortality rates. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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18 pages, 1819 KiB

Open AccessArticle

Peri-Surgical Inflammatory Profile Associated with Mini-Invasive or Standard Open Lumbar Interbody Fusion Approaches

by Giovanni Lombardi, Pedro Berjano, Riccardo Cecchinato, Francesco Langella, Silvia Perego, Veronica Sansoni, Fulvio Tartara, Pietro Regazzoni and Claudio Lamartina

J. Clin. Med. 2021, 10(14), 3128; https://doi.org/10.3390/jcm10143128 - 15 Jul 2021

Cited by 1 | Viewed by 30803

Abstract

Background: Different surgical approaches are available for lumbar interbody fusion (LIF) to treat disc degeneration. However, a quantification of their invasiveness is lacking, and the definition of minimally invasive surgery (MIS) has not been biochemically detailed. We aimed at characterizing the inflammatory, hematological, and clinical peri-surgical responses to different LIF techniques. Methods: 68 healthy subjects affected by single-level discopathy (L3 to S1) were addressed to MIS, anterior (ALIF, n = 21) or lateral (LLIF, n = 23), and conventional approaches, transforaminal (TLIF, n = 24), based on the preoperative clinical assessment. Venous blood samples were taken 24 h before the surgery and 24 and 72 h after surgery to assess a wide panel of inflammatory and hematological markers. Results: martial (serum iron and transferrin) and pro-angiogenic profiles (MMP-2, TWEAK) were improved in ALIF and LLIF compared to TLIF, while the acute phase response (C-reactive protein, sCD163) was enhanced in LLIF. Conclusions: MIS procedures (ALIF and LLIF) associated with a reduced incidence of post-operative anemic status, faster recovery, and enhanced pro-angiogenic stimuli compared with TLIF. LLIF associated with an earlier activation of innate immune mechanisms than ALIF and TLIF. The trend of the inflammation markers confirms that the theoretically defined mini-invasive procedures behave as such. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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11 pages, 1751 KiB

Open AccessArticle

Optimized Surgical Strategy for Adult Spinal Deformity: Quantitative Lordosis Correction versus Lordosis Morphology

by Sang-Kyu Im, Ki Young Lee, Hae Seong Lim, Dong Uk Suh and Jung-Hee Lee

J. Clin. Med. 2021, 10(9), 1867; https://doi.org/10.3390/jcm10091867 - 26 Apr 2021

Cited by 6 | Viewed by 2719

Abstract

Background: In surgical correction of adult spinal deformity (ASD), pelvic incidence (PI)-lumbar lordosis (LL) plays a key role to restore normal sagittal alignment. Recently, it has been found that postoperative lordosis morphology act as an important factor in preventing mechanical complications. However, there have been no studies on the effect of postoperative lordosis morphology on the restoration of sagittal alignment. The primary objective of this study was to evaluate the effect of postoperative lordosis morphology on achievement of optimal sagittal alignment. The secondary objective was to find out which radiographic or morphologic parameter affects sagittal alignment in surgical correction of ASD. Methods: 228 consecutive patients with lumbar degenerative kyphosis who underwent deformity correction and long-segment fixation from T10 to S1 with sacropelvic fixation and follow-up over 2 years were enrolled. Patients were divided according to whether optimal alignment was achieved (balanced group) or not (non-balanced group) at last follow-up. We analyzed the differences of postoperative radiographic parameters and morphologic parameters between two groups. Correlation analysis and stepwise multiple linear regression analysis was performed to predict the effect of PI-LL and morphologic parameters on the sagittal vertical axis (SVA). Results: Of 228 patients, 195 (85.5%) achieved optimal alignment at last follow-up. Two groups significantly differed in postoperative and last follow-up LL (p < 0.001 and p = 0.028, respectively) and postoperative and last follow-up PI-LL (p < 0.001 and p = 0.001, respectively). Morphologic parameters did not significantly differ between the two groups except lower lordosis arc angle (=postoperative sacral slope). In correlation analysis and stepwise multiple linear regression analysis, postoperative PI-LL was the only parameter which had significant association with last follow-up SVA (R² = 0.134, p < 0.001). Morphologic parameters did not have any association with last follow-up SVA. Conclusions: When planning spine reconstruction surgery, although considering postoperative lordosis morphology is necessary, it is still very important considering proportional lordosis correction based on individual spinopelvic alignment (PI-LL) to achieve optimal sagittal alignment. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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15 pages, 3270 KiB

Open AccessArticle

Influence of Chêneau-Brace Therapy on Lumbar and Thoracic Spine and Its Interdependency with Cervical Spine Alignment in Patients with Adolescent Idiopathic Scoliosis (AIS)

by Wojciech Pepke, Aly El Zeneiny, Haidara Almansour, Thomas Bruckner, Stefan Hemmer and Michael Akbar

J. Clin. Med. 2021, 10(9), 1849; https://doi.org/10.3390/jcm10091849 - 23 Apr 2021

Cited by 6 | Viewed by 2862

Abstract

Chêneau-brace is an effective therapy tool for treatment in adolescent idiopathic scoliosis (AIS). Data on potential interdependent changes of the sagittal profile including the cervical spine are still sparse. The purpose of this study was to evaluate in-brace changes of the thoracic and lumbar spine and their influence on the pelvis and the cervical spine and apical vertebral rotation was reported. Ninety-three patients with AIS undergoing Chêneau-bracing were included. Patients were stratified by lumbar, thoracic and global spine alignment into normolordotic vs. hyperlordotic or normokyphotic vs. hypokyphotic or anteriorly aligned vs. posteriorly aligned groups. The coronal Cobb angle was significantly decreased in all groups indicating good correction while in-brace therapy. Sagittally, in-brace treatment led to significant flattening of lumbar lordosis (LL) in all stratified groups. Thoracic kyphosis (TK) was significantly flattened in the normokyphotic group, but no TK changes were noticed in the hypokyphotic group. Pelvic tilt (PT) stayed unchanged during the in-brace therapy. Chêneau-brace showed marginal changes in the lower cervical spine but had no influence on the upper cervical spine. The apical vertebral axis in primary and secondary curves was unchanged during the first radiological follow-up. Results from this study contribute to better understanding of initial spine behavior in sagittal and axial plane in the context of bracing. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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12 pages, 2898 KiB

Open AccessArticle

The Novel Technique of Uniportal Endoscopic Interlaminar Contralateral Approach for Coexisting L5-S1 Lateral Recess, Foraminal, and Extraforaminal Stenosis and Its Clinical Outcomes

by Ji Yeon Kim, Hyeun Sung Kim, Jun Bok Jeon, Jun Hyung Lee, Jun Hwan Park and Il-Tae Jang

J. Clin. Med. 2021, 10(7), 1364; https://doi.org/10.3390/jcm10071364 - 26 Mar 2021

Cited by 22 | Viewed by 5362

Abstract

Background: Multifocal intra-and-extraspinal lumbar stenotic lesions could be decompressed with one endoscopic surgical approach, which has the advantages of functional structure preservation, technical efficacy, and safety. Methods: A retrospective study was performed on 48 patients who underwent uniportal endoscopic contralateral approach due to coexisting lateral recess, foraminal, and extraforaminal stenosis at the L5-S1 level. Foraminal stenosis grade and postoperative dysesthesia (POD) were analyzed. Visual analog scale (VAS) pain scores, modified Oswestry Disability Index (ODI) scores, and MacNab criteria for evaluating pain disability and response were analyzed. Results: The foraminal stenosis grade of the treated spinal levels was grade 1 (n = 16, 33%), grade 2 (n = 20, 42%), and grade 3 (n = 12, 25%). The rate of occurrence of POD grade 2 and above, which may be related to intraoperative dorsal root ganglion (DRG) retraction injury, was revealed to be 4.2% (two with grade 2, none with grade 3). The patients showed favorable clinical outcomes. Conclusions: Uniportal endoscopic interlaminar contralateral approach is an effective procedure to resolve combined stenosis (lateral recess, foraminal, and extraforaminal region) with one surgical approach at the L5-S1 level. It may be a minimal DRG retracting and facet joint preserving procedure in foraminal and extraforaminal decompression. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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14 pages, 3015 KiB

Open AccessArticle

Investigation of Risk Factors for Pain Chronification in Patients Suffering from Infections of the Spine

by Yina Zhao, Stefan Hemmer, Wojciech Pepke, Michael Akbar, Marcus Schiltenwolf and Ulrike Dapunt

J. Clin. Med. 2020, 9(12), 4056; https://doi.org/10.3390/jcm9124056 - 15 Dec 2020

Cited by 1 | Viewed by 1856

Abstract

Background: Spinal infections represent a therapeutic challenge. The often protracted course of the disease is accompanied by pain, which can lead to a chronic pain experience even after the infectious disease has been treated successfully. The aim of this study was to investigate possible risk factors of pain chronification. Methods: In a prospective study, 14 patients with spinal infections were examined at admission (T1), at discharge from inpatient therapy (T2), and three to eight months postoperatively (T3) byquestionnaires on risk factors for pain chronification and by quantitative sensory testing (QST). Results: In-patient treatment lasted on average 45.3 days (±33.13). The patients complained of pain for 3.43 months (±2.77) prior to inpatient treatment. The visual analogue scale (VAS) for pain (0–10) and the Oswestry Disability Index detected significant improvement in the course of the study. However, patients also reported catastrophic thinking, as well as fear of movement and (re)-injury. Conclusion: In summary, our results demonstrate that patients with spinal infections did not suffer from pain chronification, but might benefit from an interdisciplinary therapeutic approach, which emphasizes promoting active pain-coping strategies, as well as addressing fear of movement and catastrophic thinking. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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9 pages, 2546 KiB

Open AccessArticle

Evaluation of Dram Score as a Predictor of Poor Postoperative Outcome in Spine Surgery

by Antonio Serrano-García, Manuel Fernández-González, Jesús Betegón-Nicolás, Julio Villar-Pérez, Ana Lozano-Muñoz, José Hernández-Encinas, Ignacio Fernández-Bances, Marta Esteban-Blanco and Jesús Ángel Seco-Calvo

J. Clin. Med. 2020, 9(12), 3825; https://doi.org/10.3390/jcm9123825 - 26 Nov 2020

Cited by 4 | Viewed by 2024

Abstract

The Distress Risk Assessment Method (DRAM) was presented by Main, Wood and Hillis in 1992 as a simple means of assessing the risk of failure due to psychosocial factors in spine surgery. To our knowledge, it has not been used in our setting. The aim of this study was to analyse the usefulness of the Spanish translation of this instrument to predict poor outcomes. Methods: A prospective blind study was conducted including 65 patients undergoing spine surgery. We created two groups of patients based on DRAM score: not distressed (NDRAM) or distressed (DDRAM). A visual analogue scale for pain and the 12-Item Short Form Health Survey (SF-12) were used at baseline, 6 weeks and 6 months. Results: 24 patients were classified as DDRAM and 38 as NDRAM, with 3 patients not completing the questionnaires. The analysis found no significant differences in the demographic or clinical variables at baseline. At 6 weeks and 6 months, the NDRAM group showed improvements in low back pain (p < 0.001; p = 0.005), leg pain (p < 0.001; p = 0.017), physical health (p = 0.031; p = 0.003) and mental health (p = 0.137; p = 0.049). In contrast, in the DDRAM group, though leg pain score improved (p < 0.001; p = 0.002), there was no improvement at 6 weeks or 6 months in low back pain (p = 0.108; p = 0.287), physical health (p = 0.620; p = 0.263) or mental health (p = 0.185; p = 0.329). Conclusions: In our setting, the DRAM is a useful screening tool, and it has allowed the creation of a program between psychiatry and spine surgery. Full article

(This article belongs to the Special Issue Recent Advances in Spine Surgery)

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