Purpose: To determine the risk factors for pulmonary complications after minimally invasive surgery in elderly patients with vertebral compression fractures (VCFs). Methods: We retrospectively analyzed 233 elderly patients (age ≥ 65 years) with VCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) surgery at Hebei General Hospital from January 2011 to December 2016 . Risk factors and the effects of the model were determined by univariate logistic regression analyses and the receiver operating characteristic (ROC) curve, respectively. A risk assessment scale was established based on the risk factors and physiological and surgical scores for mortality and morbidity. The risk assessment scale prospectively evaluated risk factors of pulmonary complications after minimally invasive surgery for elderly patients with VCFs from January to June 2017. Results: A total of 27 patients diagnosed with pulmonary complications (11.59%) among 233 detected patients. There were statistically significant differences in age, body mass index (BMI), smoking, cardiovascular diseases and old fractures between patients with and without pulmonary complications (P<0.05). Logistic regression analysis showed that smoking, cardiovascular diseases and old fractures were risk factors of pulmonary complications after PVP or PKP for elderly patients with VCFs (P<0.05) and area under the curve was 0.738 (95% confidence intervals (CI): 0.648-0.828). We assessed 53 elderly patients with VCFs, 5 of whom occurred pulmonary complications after PVP or PKP. Areas under the curve of preoperative and total risk assessment values were all 0.925. Conclusions: Significant risk factors of pulmonary complications were BMI, cardiovascular diseases and old fractures for patients aged 65 years or elderly with VCFs after minimally invasive surgery. The risk assessment scale established by us gaining high accuracy.
Object: This study was a retrospective multivariable analysis for risk factors of poor outcome in patients underwent anterior hybrid approach, and discussed the causes of worsening of postoperative local alignment.Methods: A total of 86 patients with progressive spinal cord compression and local kyphosis underwent an anterior hybrid approach (ACDF+ACCF), between June 2011 and June 2017. We evaluated clinical outcome by the Japanese Orthopaedic Association (JOA) score and recovery rate. Patients were divided into two groups according to worsening and improving of postoperative local alignment. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were applied to the evaluation of risk factors. Mann–Whitney U-test, Independent t-test and Chi-squared test was performed for the comparison of local kyphosis between postoperative and last follow-up.Results: There were twenty patients who had a recovery rate of less than 50%. Advance age, longer duration of symptoms, bigger T1 slope angle and lower change of local kyphosis angle was significantly associated with a poor clinical outcome by multivariate logistic regression analysis. The ROC curve showed that the cutoff values of change of local angle between preoperative and last follow-up was 10.2 angle. The cause of worsening of postoperative local alignment had T1 slope, C2-7 sagittal vertical axis (SVA), adjacent segment degeneration (ASD), and implant subsidence.Conclusions: The change of local kyphosis was a predictor of clinical outcome after the hybrid approach. Furthermore, postoperative ASD, implant subsidence, T1 slope and C2-7 Cobb were associated with recurrence of postoperative cervical kyphosis.
Background: Cervical sagittal alignment (CSA) is closely related with cervical disc degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.Methods: Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analogue scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.Results: Patients who complained of ANP were categorized as ANP group (VAS score≥3; n=92), while those without ANP were categorized as non-ANP group (VAS score<3; n=171). There was no significant between-group difference with respect to age (P=0.196), gender (P=0.516), TIA (P=0.139), NT (P=0.676), CK type (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585), or cervical disc degeneration (P=0.695). The T1 slope and C2-7 SVA in the ANP group was significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P=0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P=0.028) were identified as risk factors for ANP.Conclusions: Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.
Objective. The study aimed to investigate the correlation between the severity of disease and postoperative neurological recovery in patients with cervical spondylotic myelopathy (CSM) combined with developmental spinal stenosis. Methods. A retrospective analysis of the clinical data of 114 CSM patients combined with developmental spinal stenosis admitted to our hospital from June 2019 to June 2020 was performed. All of the patients who underwent posterior cervical unidoor vertebroplasty were divided into the mild, moderate, and severe groups according to the Torg–Pavlov ratio. The clinical data including patients’ age, course of spinal cord high signal change, and first onset age were collected. The recovery time, preoperative, and postoperative Japanese Orthopaedic Association (JOA) scores of patients in each group were compared with the calculation of the improvement rate. The correlation between the severity of disease and postoperative neurological recovery in CSM patients combined with developmental spinal stenosis was analyzed by Pearson correlation. The factors influencing postoperative neurological recovery were analyzed using multivariate logistic regression analysis. The receiver operating characteristic curve (AUC) was used to evaluate the value of each influencing factor in predicting postoperative recovery. Results. Significant differences were observed in the proportion of linear hyperintensity changes in the spinal cord, the age of first onset, the course of the disease, and the Torg–Pavlov ratio among the mild, moderate, and severe groups ( P < 0 . 05 ). The postoperative recovery time of the moderate and severe groups was significantly higher than that of the mild group, while the preoperative JOA score was significantly lower than that of the mild group. On the other hand, the postoperative recovery time of the severe group was prominently higher than that of the moderate group, whereas the preoperative JOA score was observably lower than that of the moderate group ( P < 0 . 05 ). Pearson correlation analysis showed that the postoperative recovery time was significantly negatively correlated with the Torg–Pavlov ratio, age at first onset, and disease course (r = −0.359, −0.502, −0.368, P < 0 . 05 ), while it was positively correlated with spinal cord linear high-signal changes (r = 0.641, P < 0 . 05 ). Multifactorial logistic regression analysis revealed that the Torg–Pavlov ratio, age at first onset, and disease course were protective factors, while spinal cord linear high-signal alterations were risk factors affecting the recovery time of postoperative neurological function ( P < 0 . 05 ). The area under the curve (AUC) of the Torg–Pavlov ratio, linear hyperintensity changes in the spinal cord, age at first onset, and disease duration in predicting the postoperative neurological recovery time were 0.794, 0.767, 0.772, and 0.802, respectively. The AUC predicted by the combined detection of each factor was 0.876, which was better than the area under the curve of single prediction. Conclusion. Patients with CSM combined with developmental spinal stenosis were characterized by younger age of onset, a short course of the disease, and linear changes in the spinal cord high signal. The degree of developmental spinal stenosis may affect the postoperative recovery time of neurological function in CSM patients but had little effect on postoperative neurological recovery. The Torg–Pavlov ratio, age of first onset, course of the disease, and changes in the spinal cord linear hyperintensity were the factors that affected postoperative neurological recovery, which may provide a basis for reasonably predicting a postoperative neurological recovery in patients with CSM combined with developmental spinal stenosis.
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