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Berreta RS, Zhang H, Alsoof D, Khatri S, Casey J, McDonald CL, Diebo BG, Kuris EO, Basques BA, Daniels AH. Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost. World Neurosurg 2023; 178:e331-e338. [PMID: 37480985 DOI: 10.1016/j.wneu.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. METHODS The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. RESULTS In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). CONCLUSIONS Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost.
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Affiliation(s)
| | - Helen Zhang
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Surya Khatri
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jack Casey
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Eren O Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bryce A Basques
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
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Scheyerer MJ, Lenz M, Jacobs C, Pumberger M, Spiegl UJA, Ullrich BW, von der Höh N, Schnake KJ. Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization. Global Spine J 2023; 13:6S-12S. [PMID: 37084354 PMCID: PMC10177309 DOI: 10.1177/21925682221130050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with poor clinical results. METHODS We carried out a comprehensive, systematic literature search according to the PRISMA checklist and algorithm. Risk factors for perioperative complications, for early inpatient readmission, for the duration of the hospital stay, the hospital mortality, the total mortality and the clinical result were analyzed. RESULTS A total of 739 potentially usable studies were identified. After considering all inclusion and exclusion criteria, 15 studies with 15,515 patients were included. Non-adjustable risk factors were age >90 years (OR 3.27), male gender (OR 1.41), BMI less than 18.5 kg/m2 (OR 3.97), ASA score >3 (OR 2.7), activity of daily live (ADL) (OR 1.52), dependence (OR 5.68), inpatient admission status (OR 3.22), Parkinson disease (OR 3.63) and disseminated cancer (OR 2.98). Adjustable factors were insufficient kidney function (GFR <60 mL/min, and Creatinine Clearance below 60 mg/dl) (OR 4.4), nutrition status (hypalbuminemia (<3.5 g/dl)), liver function (OR 8.9) and further cardiac and pulmonary comorbidities. DISCUSSION We identified a couple of non-adjustable risk factors, which should be considered preoperatively in terms of risk assessment. However, even more important were adjustable factors that can be influenced preoperatively. In conclusion, we recommend a perioperative interdisciplinary cooperation, especially with geriatricians, to achieve the best possible clinical results in geriatric patients undergoing surgery for OVCF.
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Affiliation(s)
- Max J Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital, Düsseldorf, Germany
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Max Lenz
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Cornelius Jacobs
- Center for Spine Surgery, St Remigius Hospital Leverkusen, Leverkusen, Germany
| | - Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig
| | - Bernhard W Ullrich
- Department of Trauma and Reconstructive Surgery, Halle, Germany
- Department of Trauma Hand and Reconstructive Surgery, University Hospital Jena, Jena Germany
| | - Nicolas von der Höh
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Waldkrankenhaus Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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Spindler P, Alzoobi Y, Truckenmüller P, Hahn S, Manzoni YN, Feldmann L, Hermann KG, Kühn AA, Faust K, Schneider GH, Vajkoczy P, Schmidt H. A noninvasive method to quantify the impairment of spinal motion ability in Parkinson's disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3316-3323. [PMID: 36194297 DOI: 10.1007/s00586-022-07401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE There is a high demand on spinal surgery in patients with Parkinson's disease (PD) but the results are sobering. Although detailed clinical and radiological diagnostics were carried out with great effort and expense, the biodynamic properties of the spine of PD patients have never been considered. We propose a noninvasive method to quantify the impairment of motion abilities in patients with PD. METHODS We present an analytical cross-sectional study of 21 patients with severe PD. All patients underwent a biodynamic assessment during a standardized movement-choreography. Thus, individual spinal motion profiles of each patient were objectively assessed and compared with a large comparative cohort of individuals without PD. Moreover, clinical scores to quantify motor function and lumbar back pain were collected and X-ray scans of the spine in standing position were taken and analysed. RESULTS Biodynamic measurement showed that 36.9% of the assessed motions of all PD patients were severely impaired. Men were generally more functionally impaired than women, in 52% of all motion parameters. The neurological and radiological diagnostics recorded pathological values, of which UPDRS-III ON correlated with findings of the biodynamics assessment (R = 0.52, p = 0.02). CONCLUSIONS The decision to operate on a PD patient's spine is far-reaching and requires careful consideration. Neurological and radiological scores did not correlate with the biodynamics of the spine. The resulting motion profile could be used as individual predictive factor to estimate whether patients are eligible for spinal surgery or alternative therapies.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Truckenmüller
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Sabine Hahn
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yves N Manzoni
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Lucia Feldmann
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kay-Geert Hermann
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Zhan Y, He G, Yang H, Gao W, Yuan W, Sun H, Hao D, Wang B. Consecutive Kummell's Disease Combined with Parkinson's Disease and Experienced Internal Fixation Failure: A Case Report and Literature Review. Orthop Surg 2022; 14:1533-1540. [PMID: 35633056 PMCID: PMC9251324 DOI: 10.1111/os.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background The continuous occurrence of Kummell's disease is extremely rare in clinical practice, and its treatment is difficult. The study aimed to present a rare case of consecutive Kummell's disease combined with Parkinson's disease (PD) and experienced internal fixation failure. Case presentation A 69‐year‐old female patient had a history of PD for 10 years, and was treated by posterior decompression, fixation, and fusion because of Kummell's disease of T12 with neurological damage. The patient's back pain and lower limb pain were significantly improved after surgery. Twenty‐two months later, the patient was rehospitalized for Kummell's disease of L4 with neuropathic pain of left lower extremity. She received almost identical surgical procedures as T12 lesion, and the difference was no L4 vertebroplasty preformed due to the fact that the L4 vertebrae collapse was not obvious, the intravertebral vacuum cleft (IVC) range was small, and the pedicle screw fixation strength was high. The pain symptoms were significantly relieved after operation. Unfortunately, there was a complication of internal fixation failure that occurred a month later, and a revision operation was carried out. Conclusion Osteoporosis combined with PD may lead patients to become prone to consecutive Kummell's disease, and patients are prone to experience failure of internal fixation. Bone cement filling of vertebral IVC and effective support of anterior vertebral column are very important procedures to ensure the clinical efficacy of treating Kummell's disease.
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Affiliation(s)
- Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.,Shaanxi University of Chinese Medicine, Xi'an, China
| | - Guiping He
- Department of Bone and Joint Rehabilitation, Pingliang Rehabilitation Center Hospital, Pingliang, China
| | - Huiming Yang
- Department of Orthopaedics, Shehong Municipal Hospital of TCM, Shehong, China
| | - Wenjie Gao
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Yuan
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Honghui Sun
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
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Spindler P, Tkatschenko D, Alzoobi Y, Kuebler D, Kühn AA, Schneider GH, Prinz V, Vajkoczy P, Faust K. Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study. J Neurol Surg A Cent Eur Neurosurg 2022; 84:247-254. [PMID: 35100633 DOI: 10.1055/s-0041-1741535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. METHODS In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. RESULTS We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). CONCLUSION PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dorothee Kuebler
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
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6
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LI X, XU J, NI C, GU M. Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.30421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Xia LI
- Nanjing University of Chinese Medicine, China
| | - Jing XU
- Nanjing University of Chinese Medicine, China
| | | | - Minhui GU
- Nanjing University of Chinese Medicine, China
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7
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Spindler P, Alzoobi Y, Kühn AA, Faust K, Schneider GH, Vajkoczy P. Deep brain stimulation for Parkinson's disease-related postural abnormalities: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3083-3092. [PMID: 35790655 PMCID: PMC9492622 DOI: 10.1007/s10143-022-01830-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 02/03/2023]
Abstract
Deep brain stimulation (DBS) has become a well-established treatment modality for Parkinson's disease (PD), especially regarding motor fluctuations, dyskinesias, and tremor. Although postural abnormalities (i.e., Camptocormia [CC] and Pisa syndrome [Pisa]) are known to be a major symptom of PD as well, the influence of DBS on postural abnormalities is unclear. The objective of this study is to analyze the existing literature regarding DBS for PD-associated postural abnormalities in a systematic review and meta-analysis. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of 18 studies that reported the effect of DBS regarding postural abnormalities. After screening of 53 studies, a total of 98 patients (44 female, 53 males, 1 not reported; mean age: 62.3, range 30-83 years) with postural abnormalities (CC n = 98; Pisa n = 11) were analyzed from 18 included studies. Of those patients, 94.9% underwent STN-DBS and 5.1% had GPi as DBS target area. A positive outcome was reported for 67.8% with CC and 72.2% with Pisa. In the meta-analysis, younger age and lower pre-operative UPDRS-III (ON/OFF) were found as positive predictive factors for a positive effect of DBS. DBS might be a potentially effective treatment option for PD-associated postural abnormalities. However, the level of evidence is rather low, and definition of postoperative outcome is heterogenous between studies. Therefore larger, prospective trials are necessary to give a clear recommendation.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Umakoshi M, Yasuhara T, Morimoto J, Murai S, Sasaki T, Kameda M, Kin K, Miyoshi Y, Date I. Spinal Surgery after Bilateral Subthalamic Stimulation for Patients with Parkinson's Disease: A Retrospective Outcome Analysis of Pain and Functional Control. Neurol Med Chir (Tokyo) 2021; 61:607-618. [PMID: 34408107 PMCID: PMC8531877 DOI: 10.2176/nmc.oa.2021-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Parkinson’s disease (PD) patients often suffer from spinal diseases requiring surgeries, although the risk of complications is high. There are few reports on outcomes after spinal surgery for PD patients with deep brain stimulation (DBS). The objective of this study was to explore the data on spinal surgery for PD patients with precedent DBS. We evaluated 24 consecutive PD patients with 28 spinal surgeries from 2007 to 2017 who received at least a 2-year follow-up. The characteristics and outcomes of PD patients after spinal surgery were compared to those of 156 non-PD patients with degenerative spinal diseases treated in 2013–2017. Then, the characteristics, outcomes, and spinal alignment of PD patients receiving DBS were analyzed in degenerative spinal/lumbar diseases. The mean age at the time of spinal surgery was 68 years. The Hoehn and Yahr score regarding PD was stage 1 for 8 patients, stage 2 for 2 patients, stage 3 for 8 patients, stage 4 for 10 patients, and stage 5 for 0 patient. The median preoperative L-DOPA equivalent daily dose was 410 mg. Thirteen patients (46%) received precedent subthalamic nucleus (STN) DBS. Lumbar lesions with pain were common, and operation and anesthesia times were long in PD patients. Pain and functional improvement of PD patients persisted for 2 years after surgery with a higher complication rate than for non-PD patients. PD patients with STN DBS maintained better lumbar lordosis for 2 years after spinal surgery. STN DBS significantly maintained spinal alignment with subsequent pain and functional amelioration 2 years after surgery. The outcomes of spinal surgery for PD patients might be favorably affected by thorough treatment for PD including DBS.
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Affiliation(s)
- Michiari Umakoshi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Jun Morimoto
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kyohei Kin
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yasuyuki Miyoshi
- Department of Neurosurgery, Kawasaki Medical School General Medical Center
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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9
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Sapkas G, Ampadiotaki MM, Pallis D, Papadakis M, Halikiopoulos SA, Papadakis S. Complications after Spinal Surgery in Patients with Parkinson’s Disease. Open Orthop J 2021. [DOI: 10.2174/1874325002115010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Several studies have shown that spinal surgeries in patients who suffer from Parkinson’s Disease have a high rate of complications. These patients often need revision surgery.
Objective:
This is a retrospective study involving 21 patients with Parkinson’s Disease. This study aimed to examine the complications after spinal surgery.
Methods:
We studied 21 patients with Parkinson’s Disease retrospectively, who had undergone a previous operation by the same surgeon between 2004 to 2019. There were 11 females and 10 males. The mean age was 71.9 years (range, 52 to 85). However, the initial diagnosis and types of surgery were different. The mean time of follow-up for each patient was 3.6 years (ranging from 2 to 8 years).
Results:
Most of the patients had a post-operative complication within a period of three years. Τhe most common complication was kyphotic deformity and camptocormia. Twelve patients (57.1%) underwent revision surgery, and three patients (14.2%) denied treatment. In four patients (19.04%), kyphotic deformity or stooped posture remained. Only one patient (4.7%) presented with no complication in a follow-up of 8 years.
Conclusion:
Patients with Parkinson’s disease have a high rate of complications after spinal surgery and often need revision surgery. For this literature review, the overall number of patients was 502, and the mean revision rate was 43.6%. The surgeon must inform patients of possible complications, and a thorough post-operative observation must be implemented.
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Nakajima H, Kubota A, Watanabe S, Honjoh K, Matsumine A. Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson's disease. Sci Rep 2021; 11:14235. [PMID: 34244599 PMCID: PMC8270950 DOI: 10.1038/s41598-021-93798-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/01/2021] [Indexed: 01/18/2023] Open
Abstract
Osteoporosis and Parkinson's disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.
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Affiliation(s)
- Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Arisa Kubota
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Shuji Watanabe
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuya Honjoh
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Akihiko Matsumine
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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11
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Kawabata A, Yoshii T, Sakai K, Hirai T, Yuasa M, Inose H, Matsukura Y, Morishita S, Tomori M, Torigoe I, Kusano K, Otani K, Arai Y, Shindo S, Okawa A. Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson's disease: a multi-institutional retrospective cohort study. BMC Musculoskelet Disord 2021; 22:357. [PMID: 33863320 PMCID: PMC8051124 DOI: 10.1186/s12891-021-04233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Parkinson’s disease (PD) has been found to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, few studies have investigated this by directly comparing patients with PD and those without PD. Methods In this multicenter retrospective cohort study, we reviewed all surgically treated ASD patients with at least 2 years of follow-up. Among them, 27 had PD (PD+ group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. Results For early complications, the PD+ group demonstrated a higher rate of delirium than the PD− group. In terms of late complications, the rate of non-union was significantly higher in the PD+ group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD+ group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD+ group. Conclusion Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of non-union were greater in these patients.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan.
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Kazuo Kusano
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Kazuyuki Otani
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Shigeo Shindo
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
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Liu B, Chen G, Yu Z, Ji C, Liang T, He J, Dai W, Shao Y, Jiang H, Zhang W, Yang H, Luo Z. Bone Mineral Density and Related Scores in Parkinson's Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 146:e1202-e1218. [PMID: 33271382 DOI: 10.1016/j.wneu.2020.11.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common degenerative neurologic disorder in older adults, and increasing attention has been paid to bone health in PD. Although several studies have shown that patients with PD have a lower bone mineral density (BMD) than do non-PD controls, there have been no systematic reviews in recent years. METHODS PubMed, Medline, and Web of Science were used to search relevant studies up to May 2020. BMD, BMD T score, and BMD Z score of patients with and without PD were statistically analyzed. Meta-analysis was conducted using Review Manager version 5.3. RESULTS This meta-analysis included 17 studies comprising 10,289 individuals. In the meta-analysis, adults with PD had lower total body, total hip, total radius, lumbar spine, total femur, femur neck, right-hand, and left-hand BMD than did non-PD controls. The T score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, total femur BMD, and femur neck BMD in adults with PD were lower than those in non-PD controls. Futhermore, the Z score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, and femur neck BMD was lower in adults with PD than in non-PD controls. CONCLUSIONS Patients with PD had a lower BMD, BMD T score, and BMD Z score compared with non-PD controls. Therefore, clinicians should routinely monitor BMD of patients with PD to prevent falling and fragility fractures in older adults and optimize BMD before surgical treatment of severe spinal deformity caused by PD.
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Affiliation(s)
- Bo Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Guangdong Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhaohui Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Chenchen Ji
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Ting Liang
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Jiaheng He
- The Fifth Department of Orthopedics, The 903th Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Wangying Dai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huaye Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Zongping Luo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China.
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13
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Kawabata A, Yoshii T, Hirai T, Ushio S, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Matsuoka Y, Suzuki H, Nishimura H, Terai H, Tamai K, Tagami A, Yamada S, Adachi S, Watanabe K, Katsumi K, Ohashi M, Shibuya Y, Harimaya K, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Kimura A, Inoue H, Inoue G, Miyagi M, Saito W, Nakano A, Sakai D, Nukaga T, Ikegami S, Shimizu M, Futatsugi T, Ohtori S, Furuya T, Orita S, Imagama S, Ando K, Kobayashi K, Kiyasu K, Murakami H, Yoshioka K, Seki S, Hongo M, Kakutani K, Yurube T, Aoki Y, Oshima M, Takahata M, Iwata A, Endo H, Abe T, Tsukanishi T, Nakanishi K, Watanabe K, Hikata T, Suzuki S, Isogai N, Okada E, Funao H, Ueda S, Shiono Y, Nojiri K, Hosogane N, Ishii K. Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study. BMC Musculoskelet Disord 2020; 21:420. [PMID: 32611386 PMCID: PMC7331246 DOI: 10.1186/s12891-020-03452-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. Methods Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. Results A total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan.
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuji Matsuoka
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hidekazu Suzuki
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hirosuke Nishimura
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Atsushi Tagami
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Syuta Yamada
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Shinji Adachi
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Keiichi Katsumi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yohei Shibuya
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Nobuhiko Yokoyama
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Hidekazu Oishi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Toshiro Doi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Atsushi Nakano
- Department of Orthopaedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka, 569-0801, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Tadashi Nukaga
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Toshimasa Futatsugi
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku City, Kochi, 783-8505, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University, 1-1-1 Hondo, Akita City, Akita, 010-8543, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane City, Chiba, 283-8686, Japan
| | - Masashi Oshima
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University, North-15, West-7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Hokkaido University, North-15, West-7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan
| | - Hirooki Endo
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki, 305-8577, Japan
| | - Toshinori Tsukanishi
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki, 305-8577, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Seiji Ueda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Shiono
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenya Nojiri
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
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Extensive Spinal Fusion Surgery in Patients With Parkinson Disease or Atypical Parkinsonism: Time Course of Clinical Outcomes in 5 Years Progress Report. Spine (Phila Pa 1976) 2020; 45:E217-E226. [PMID: 31513098 DOI: 10.1097/brs.0000000000003246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE To clarify the mid-term results of extensive spinal fusion surgery in patients with Parkinson disease (PD) or atypical Parkinsonism, especially with respect to their activities of daily living (ADL) over time SUMMARY OF BACKGROUND DATA.: Postural disorders associated with PD lead to spinal imbalance and deformity, resulting in significant disabilities. Clinical outcomes of extensive fusion surgeries in patients with PD over a medium-term follow-up period are currently unknown. METHODS Patients with PD who underwent extensive fusion surgery more than 5 years prior were included. The patients' backgrounds, surgical and radiographic parameters, perioperative and mechanical complications, and indoor ADL over time were assessed. To assess the activities of severely disabled patients, indoor ADL was classified into four stages: independent; or cane, walker, and wheelchair use. RESULTS Twenty-two patients (mean age, 70.6 yrs) were included. The mean blood loss, duration of surgery, and fusion levels were 2039 mL, 424 minutes, and 11.9 levels, respectively. Sagittal vertical axis improved from 220 mm preoperatively to 95 mm postoperatively. Perioperative complications were observed in 17 cases (77%). Before surgery, 1, 5, 12, and four cases were independent in ADL, T-cane, walker, and wheelchair use, respectively, which improved to seven, four, six, and four, respectively in 1 year. Revision surgeries were performed in eight patients (36%) within 3 years of surgery. In the 3 to 5 years after the surgery, the ADL of nine patients worsened due to deterioration of PD. Fifteen cases were followed up over 5 years, at which one, two, four, and seven cases were independent in ADL, cane, walker, and wheelchair use, respectively. CONCLUSION Surgical intervention in PD patients with spinal deformities leads to good short-term outcomes; however, the patients' conditions deteriorated because of complications within 3 years and worsening of PD over 3 years after the surgery. LEVEL OF EVIDENCE 4.
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15
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Incidence and Risk Factors for Postoperative Delirium in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2139834. [PMID: 31886180 PMCID: PMC6899276 DOI: 10.1155/2019/2139834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Background The present study aims to investigate the incidence and risk factors associated with postoperative delirium in patients undergoing spine surgery. Methods PubMed, EMBASE, Cochrane Library, and Science Citation Index were searched up to August 2019 for studies examining postoperative delirium following spine surgery. Incidence and risk factors associated with delirium were extracted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for outcomes. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation. Results The final analysis includes a total of 40 studies. The pooled analysis reveals that incidence of delirium is 8%, and there are significant differences for developing delirium in age (OR 1.07; 95% CI 1.04-1.09), age more than 65 (OR 4.77; 95% CI 4.37-5.16), age more than 70 (OR 15.87; 95% CI 6.03-41.73), and age more than 80 (OR 1.91; 95% CI 1.78-2.03) years, male (OR 0.81; 95% CI 0.76-0.86), a history of alcohol abuse (OR 2.11; 95% CI 1.67-2.56), anxiety (OR 1.74; 95% CI 1.04-2.44), congestive heart failure (OR 1.4; 95% CI 1.21-1.6), depression (OR 2.5; 95% CI 1.52-3.49), hypertension (OR 1.12; 95% CI 1.04-1.2), kidney disease (OR 1.41; 95% CI 1.16-1.66), neurological disorder (OR 4.66; 95% CI 4.22-5.11), opioid use (OR 1.86; 95% CI 1.18-2.54), psychoses (OR 2.77; 95% CI 2.29-3.25), pulmonary disease (OR 1.81; 95% CI 1.27-2.35), higher mini-mental state examination (OR 0.7; 95% CI 0.5-0.89), preoperative pain (OR 1.88; 95% CI 1.11-2.64), and postoperative urinary tract infection (OR 5.68; 95% CI 2.41-13.39). Conclusions A comprehensive understanding of incidence and risk factors of delirium can improve prevention, diagnosis, and management. Risk of postoperative delirium can be reduced based upon identifiable risk factors.
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16
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Sakai Y, Kaito T, Takenaka S, Yamashita T, Makino T, Hosogane N, Nojiri K, Suzuki S, Okada E, Watanabe K, Funao H, Isogai N, Ueda S, Hikata T, Shiono Y, Watanabe K, Katsumi K, Fujiwara H, Nagamoto Y, Terai H, Tamai K, Matsuoka Y, Suzuki H, Nishimura H, Tagami A, Yamada S, Adachi S, Ohtori S, Orita S, Furuya T, Yoshii T, Ushio S, Inoue G, Miyagi M, Saito W, Imagama S, Ando K, Sakai D, Nukaga T, Kiyasu K, Kimura A, Inoue H, Nakano A, Harimaya K, Doi T, Kawaguchi K, Yokoyama N, Oishi H, Ikegami S, Futatsugi T, Shimizu M, Kakutani K, Yurube T, Oshima M, Uei H, Aoki Y, Takahata M, Iwata A, Seki S, Murakami H, Yoshioka K, Endo H, Hongo M, Nakanishi K, Abe T, Tsukanishi T, Ishii K. Complications after spinal fixation surgery for osteoporotic vertebral collapse with neurological deficits: Japan Association of Spine Surgeons with ambition multicenter study. J Orthop Sci 2019; 24:985-990. [PMID: 31521452 DOI: 10.1016/j.jos.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND There have been few reports on the incidence and risk factors of the complications after spinal fixation surgery for osteoporotic vertebral collapse (OVC) with neurological deficits. This study aimed to identify the incidence and risk factors of the complications after OVC surgery. METHODS In this retrospective multicenter study, a total of 403 patients (314 women and 89 men; mean age 73.8 years) who underwent spinal fixation surgery for OVC with neurological deficits between 2005 and 2014 were enrolled. Data on patient demographics were collected, including age, sex, body mass index, smoking, steroid use, medical comorbidities, and surgical procedures. All postoperative complications that occurred within 6 weeks were recorded. Patients were classified into two groups, namely, complication group and no complication group, and risk factors for postoperative complications were investigated by univariate and multivariate analyses. RESULTS Postoperative complications occurred in 57 patients (14.1%), and the most common complication was delirium (5.7%). In the univariate analysis, the complication group was found to be older (p = 0.039) and predominantly male (p = 0.049), with higher occurrence rate of liver disease (p = 0.001) and Parkinson's disease (p = 0.039) compared with the no-complication group. In the multivariate analysis, the significant independent risk factors were age (p = 0.021; odds ratio [OR] 1.051, 95% confidence interval [CI] 1.007-1.097), liver disease (p < 0.001; OR 8.993, 95% CI 2.882-28.065), and Parkinson's disease (p = 0.009; OR 3.636, 95% CI 1.378-9.599). CONCLUSIONS Complications after spinal fixation surgery for OVC with neurological deficits occurred in 14.1%. Age, liver disease, and Parkinson's disease were demonstrated to be independent risk factors for postoperative complications.
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Affiliation(s)
- Yusuke Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Shota Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takahiro Makino
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University, Mitaka, Japan
| | - Kenya Nojiri
- Department of Orthopedic Surgery, Isehara Kyodo Hospital, Isehara, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruki Funao
- Spine and Spinal Cord Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Norihiro Isogai
- Spine and Spinal Cord Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Seiji Ueda
- Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Spine Center, Kitasato Institute Hospital, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan
| | - Keiichi Katsumi
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Tagami
- Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Shuta Yamada
- Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinji Adachi
- Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Tadashi Nukaga
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Atsushi Kimura
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hirokazu Inoue
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Toshio Doi
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | | | | | - Hidekazu Oishi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Japan
| | | | - Masayuki Shimizu
- Department of Orthopedic Surgery, Matsumoto City Hospital, Matsumoto, Japan
| | - Kenichiro Kakutani
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Oshima
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Katsuhito Yoshioka
- Department of Orthopedic Surgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Hirooki Endo
- Department of Orthopedic Surgery, Iwate Medical University, Morioka, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University, Akita, Japan
| | | | - Tetsuya Abe
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Ken Ishii
- Spine and Spinal Cord Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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