Spinal disorders in the elderly

Temporal analysis of complication rates of cervical spine surgery for degenerative spine disease between younger and older cohorts using the CSORN registry: Is age just a number?

STUDY DESIGN

An ambispective review of consecutive cervical spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and September 2019.

PURPOSE

To compare complication rates of degenerative cervical spine surgery over time between older (> 65) and younger age groups (< 65). More elderly people are having spinal surgery. Few studies have examined the temporal nature of complications of cervical spine surgery by patient age groups.

METHODS

Adverse events were collected prospectively using adverse event forms. Binary logistic regression analysis was utilized to assess associations between risk modifiers and adverse events at the intra-, peri-operative and 3 months post-surgery.

RESULTS

Of the 761 patients studied (age < 65, n = 581 (76.3%) and 65 + n = 180 (23.7%), the intra-op adverse events were not significantly different; < 65 = 19 (3.3%) vs 65 +  = 11 (6.1%), p < 0.087. Peri-operatively, the < 65 group had significantly lower percentage of adverse events (65yrs (11.2%) vs. 65 +  = (26.1%), p < 0.001). There were no differences in rates of adverse events at 3 months post-surgery (< 65 = 39 (6.7%) vs. 65 +  = 12 (6.7%), p < 0.983). Less blood loss (OR = 0.99, p < 0.010) and shorter length of hospital stay (OR = 0.97, p < 0.025) were associated with not having intra-op adverse events. Peri-operatively, > 1 operated level (OR = 1.77, p < 0.041), shorter length of hospital stay (OR = 0.86, p < 0.001) and being younger than 65 years (OR = 2.11, p < 0.006) were associated with not having adverse events.

CONCLUSION

Following degenerative cervical spine surgery, the older and younger age groups had significantly different complication rates at peri-operative time points, and the intra-operative and 3-month post-operative complication rates were similar in the groups.

Effect of T1 Slope on Disappearance of Cervical Lordosis after Posterior Cervical Double-Door Laminoplasty Based on Medical Informatics

Cervical sagittal balance plays a pivotal role in spine surgeries as it has a significant impact on the clinical outcomes in cervical spine surgery. Image processing techniques have significantly improved the accuracy and precision of cervical surgical techniques. This study aims to investigate the effects of T1 slope (T1s) on the disappearance of cervical lordosis after posterior cervical double-door laminoplasty using medical informatics and radiographic measures. To do so, we determined and measured the loss of T1s and cervical lordosis during the postoperative follow-up period in patients with double-door posterior cervical laminoplasty. Patients (n = 40) who underwent posterior cervical double-door laminoplasty participated in this study. For all patients, the difference between the preoperative T1s (angle between the upper edge of T1 and the horizontal line) and preoperative and postoperative cervical lordosis (Cobb method) was estimated, and the linear relationship between the two was statistically analyzed to observe the influence of preoperative T1s on postoperative cervical lordosis disappearance. The average preoperative T1s was 23.54°, and the average preoperative cervical lordosis angle was 8.50°. After 1-20 months of follow-up (mean = 9.53 months), the average postoperative cervical lordosis was 8.50°, and the average loss of cervical lordosis was 0.22°. Twenty cases had different degrees of lordosis angle loss after the operation, with an average loss of 9.31°. All patients were divided into groups A and B, according to a mean value of T1s = 23.54°, of which T1S > 23.54° was group A and T1s < 23.54 was group B. Cervical lordosis was quantified by the C2-C7 Cobb angle. The Cobb angle difference of cervical lordosis was measured before and after the operation, and its correlation with preoperative T1s was assessed. The preoperative Cobb angle and cervical curvature changes in the two groups were statistically compared, and the difference between the two groups was statistically significant (p < 0.05). The group with a T1s > 23.54° had greater loss of preoperative Cobb angle and cervical curvature. In group A, the mean preoperative cervical disability index (NDI) was 32.4 ± 3.4, and the mean postoperative NDI score was 16.5 ± 2.1. The mean preoperative VAS scores of neck pain and neck pain were 5.41 ± 1.1 and 5.55 ± 0.3, respectively, and the improvement in neck pain was -0.2%. The mean preoperative NDI in group B was 30.1 ± 2.9, and the mean postoperative NDI score was 11.5 ± 3.1. The mean VAS score for preoperative neck pain was 5.11 ± 1.2, that for postoperative neck pain was 4.18 ± 0.7, and that for neck pain improved by 18%. There was a significant difference between the two groups (p < 0.05). The disappearance of cervical lordosis after posterior cervical double-door laminoplasty is an important cause of postoperative cervical spine pain. The T1s is meaningful for predicting the loss of postoperative curvature in patients undergoing posterior cervical double-door laminoplasty. This is especially true for patients with good preoperative cervical curvature without ankylosis and kyphosis but with a wide T1s.

Correlation of Psoas Muscle Index with Fragility Vertebral Fracture: A Retrospective Cross-Sectional Study of Middle-Aged and Elderly Women

OBJECTIVE

To investigate the correlation of psoas muscle index (PMI) with fragility vertebral fracture.

METHODS

A total of 184 middle-aged and elderly women were included in the study. We measured the bilateral psoas muscle area on the picture archiving and communication system (PACS) from computed tomography images and calculated PMI. We observed lateral radiographs of the thoracolumbar spine and assessed vertebral fractures using the Genant semiquantitative method. The T-score, bone mineral density (BMD) of the lumbar (L)1-4, femoral neck, and trochanter were measured by dual-energyX-ray absorptiometry (DXA). The data was collected and then statistically analyzed.

RESULTS

The PMI of the nonosteoporosis group was higher than that of the osteoporosis group (P value = 0.006). Height in the nonosteoporosis group was higher than that in the osteoporosis group (P value = 0.013). Weight, body mass index (BMI), left psoas muscle area, BMD of the L1-4, femoral neck, femoral trochanter, and T-score in the nonosteoporosis group were higher than those in the osteoporosis group (P value <0.001). The right psoas muscle area in the nonosteoporosis group was higher than that in the osteoporosis group (P value = 0.008). The incidence of combined thoracolumbar fracture was significantly higher in the osteoporosis group than that in the nonosteoporosis group (P value <0.001). For nonosteoporosis subjects, the PMI of the vertebral fracture group was lower than that of the nonvertebral fracture group (P value = 0.034).

CONCLUSIONS

A decrease in height, weight, BMI, bilateral psoas muscle area, and PMI is associated with osteoporosis. Combined thoracolumbar fractures are more common in osteoporosis. Sarcopenia may be an independent risk factor for nonosteoporotic vertebral fractures.

Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2,320 patients

BACKGROUND CONTEXT

There is a paucity of literature describing risk factors for adverse outcomes after geriatric lumbar spinal surgery. As the geriatric population increases, so does the number of lumbar spinal surgeries in this cohort.

PURPOSE

The purpose of the study was to determine how safe lumbar surgery is in elderly patients. Does patient selection, type of surgery, length of surgery, and other comorbidities in the elderly patient affect complication and readmission rates after surgery?

STUDY DESIGN/SETTING

This is a retrospective cohort study.

PATIENT SAMPLE

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database was used in the study.

OUTCOME MEASURES

The outcome data that were analyzed were minor and major complications, mortality, and readmissions in geriatric patients who underwent lumbar spinal surgery from 2005 to 2015.

MATERIALS AND METHODS

A retrospective cohort study was performed using data from the ACS NSQIP database. Patients over the age of 80 years who underwent lumbar spinal surgery from 2005 to 2013 were identified using International Statistical Classification of Diseases and Related Health Problems diagnosis codes and Current Procedural Terminology codes. Outcome data were classified as either a major complication, minor complication, readmission, or mortality. Multivariate logistic regression models were used to determine risks for developing adverse outcomes in the initial 30 postoperative days.

RESULTS

A total of 2,320 patients over the age of 80 years who underwent lumbar spine surgery were identified. Overall, 379 (16.34%) patients experienced at least one complication or death. Seventy-five patients (3.23%) experienced a major complication. Three hundred thirty-eight patients (14.57%) experienced a minor complication. Eighty-six patients (6.39%) were readmitted to the hospital within 30 days. Ten deaths (0.43%) were recorded in the initial 30 postoperative days. Increased operative times were strongly associated with perioperative complications (operative time >180 minutes, odds ratio [OR]: 3.07 [95% confidence interval {CI} 2.23-4.22]; operative time 120-180 minutes, OR: 1.77 [95% CI 1.27-2.47]). Instrumentation and fusion procedures were also associated with an increased risk of developing a complication (OR: 2.56 [95% CI 1.66-3.94]). Readmission was strongly associated with patients who were considered underweight (body mass index [BMI] <18.5) and who were functionally debilitated at the time of admission (OR: 4.10 [1.08-15.48] and OR: 2.79 [1.40-5.56], respectively).

CONCLUSIONS

Elderly patients undergoing lumbar spinal surgery have high complications and readmission rates. Risk factors for complications include longer operative time and more extensive procedures involving instrumentation and fusion. Higher readmission rates are associated with low baseline patient functional status and low patient BMI.

The use of computed tomography attenuation to evaluate osteoporosis following acute fractures of the thoracic and lumbar vertebra

BACKGROUND

Relatively few patients have dual-energy x-ray absorptiometry to quantify the magnitude of bone loss as they age. Recent work correlates mean computed tomography (CT) attenuation in the level I (L1) vertebra with bone mineral density (BMD), making it possible to objectively evaluate the magnitude of bone loss in osteoporosis by this method. The aims of this study were to evaluate the utility of using CT scans in patients with acute thoracic and lumbar spine fractures to diagnose osteoporosis and using CT attenuation to evaluate the association between age and BMD.

METHODS

We performed a retrospective study of patients with acute fractures of the thoracic or lumbar spine who had also undergone an abdominal (or L1) CT scan and compared mean CT attenuation in L1 against threshold values. We also compared differences in CT attenuation between younger (<65 years) and older (≥65 years) and older patients.

RESULTS

A total of 124 patients were evaluated (74 thoracic and 50 lumbar fractures). Overall, there was a strong correlation between age and bone density as measured by CT attenuation (r = -.76). Among those with thoracic fractures (<65 years), mean CT attenuation was 196.51 HU. Forty-one patients were ≥65 years and had mean CT attenuation of 105.90 HU (P < .001). In patients with lumbar fractures, 27 patients were <65 years and had a mean CT attenuation of 192.26 HU and 23 patients were ≥65 years and had mean CT attenuation of 114.31 HU (P < .001). At the threshold of 110 HU, set for specificity, the magnitude of difference between the age-stratified cohorts was greater in the thoracic spine (P < .0001 vs P = .003).

DISCUSSION

Using opportunistic CT, we demonstrate the relative frequency of osteoporosis in patients with acute fractures of the thoracic and lumbar spine and confirm that the association increases with age. The CT attenuation may provide a cheap and convenient method to help confirm a clinical diagnosis of osteoporosis in patients with fractures.

Bryan cervical disc prosthesis: 12-month clinical outcome

A prospective observational clinical study was carried out to determine whether Bryan disc replacement surgery is a suitable alternative to arthrodesis for cervical disc disease.