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The purpose of this study was to explore incidence and risk factors of adjacent segment disease (ASD) following posterior decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for both spinal surgeon and surgically treated patients.By retrieving the medical records from January 2011 to December 2013 in our hospital, 237 patients were retrospectively reviewed. According to the occurrence of ASD at follow up, patients were divided into 2 groups: ASD and N-ASD group. To investigate risk values for the occurrence of ASD, 3 categorized factors were analyzed statistically: Patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), duration. Surgical variables: surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, intraoperative superior facet joint violation. Radiographic parameters: preoperative lumbar lordosis, preoperative angular motion at adjacent segment, preoperative adjacent segment disc degeneration, preoperative paraspinal muscle degeneration.Postoperative ASD was developed in 15 of 237 patients (6.3%) at final follow up. There was no statistically significant difference between the 2 groups in patient characteristics of age, sex composition, BMD, duration, while the BMI was higher in ASD group than that in N-ASD group. There was no difference in surgical variables of surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, while intraoperative superior facet joint violation was more common in ASD group than that in N-ASD group. There was no difference in radiographic parameters of preoperative lumbar lordosis, preoperative paraspinal muscle degeneration, while preoperative adjacent segment disc degeneration were more severe in ASD group than that in N-ASD group. The Logistic regression analysis revealed that, BMI >25 kg/m2, preoperative disc degeneration, and superior facet joint violation were independently associated with ASD.In conclusion, higher BMI, preoperative disc degeneration at adjacent segment and intraoperative superior facet joint violation are risk factors for ASD. Patients who are overweight or obesity and with preoperative disc degeneration at adjacent segment should be fully informed the risk of ASD. For surgeons, it is essential to prevent superior facet joint violation in pedicle screw insertion procedure.

BackgroundAlthough correctional officers (COs) clearly suffer from depression, positive resources for combating depression have been rarely studied in this population. The purpose of the study was to examine the associations of perceived organizational support (POS) and psychological capital (PsyCap) with depressive symptoms among Chinese COs.MethodsA cross-sectional survey was conducted in a province of northeast China during March–April 2011. A self-administered questionnaire was distributed to 1900 male COs from four male prisons. Depressive symptoms, POS, and PsyCap (self efficacy, hope, resilience, and optimism) were measured anonymously. A total of 1428 effective respondents with 953 frontline COs (FL-COs) and 475 non-frontline COs (NFL-COs) became our final sample. Hierarchical linear regression was performed to explore the factors associated with depressive symptoms. Asymptotic and resampling strategies were used to examine the mediating roles of PsyCap and its four components.ResultsThe level of depressive symptoms of FL-COs was significantly higher than that of NFL-COs (t = 2.28, p = 0.023). There were significant negative associations of POS, PsyCap, hope, resilience, and optimism with depressive symptoms among FL-COs. In NFL-COs, POS, PsyCap, and optimism were negatively associated with depressive symptoms. POS was positively associated with PsyCap and its four components among both FL-COs and NFL-COs. For FL-COs, PsyCap (a*b = −0.143, BCa 95% CI: –0.186, –0.103, p < 0.05), resilience (a*b = −0.052, BCa 95% CI: –0.090, –0.017, p < 0.05), and optimism (a*b = −0.053, BCa 95% CI: –0.090, –0.016, p < 0.05) significantly mediated the association between POS and depressive symptoms. For NFL-COs, PsyCap (a*b = −0.126, BCa 95% CI: –0.186, –0.065, p < 0.05) and optimism (a*b = −0.066, BCa 95% CI: –0.116, –0.008, p < 0.05) significantly mediated the association.ConclusionsPerceived organizational support and psychological capital could be positive resources for combating depressive symptoms in Chinese male COs. Psychological capital and its components (resilience and optimism) partially mediate the association between perceived organizational support and depressive symptoms. Therefore, organizational support and psychological capital investment (especially resilience and optimism) should be included in depression preventions and treatments targeting Chinese male COs.