المؤلفون: Segi, Naoki, Nakashima, Hiroaki, Ito, Sadayuki, Yokogawa, Noriaki, Sasagawa, Takeshi, Watanabe, Kota, Nori, Satoshi, Funayama, Toru, Eto, Fumihiko, Nakajima, Hideaki, Terashima, Yoshinori, Hirota, Ryosuke, Hashimoto, Ko, Onoda, Yoshito, Furuya, Takeo, Yunde, Atsushi, Ikegami, Shota, Uehara, Masashi, Suzuki, Hidenori, Imajo, Yasuaki, Uei, Hiroshi, Sawada, Hirokatsu, Kawaguchi, Kenichi, Nakanishi, Kazuo, Suzuki, Nobuyuki, Oshima, Yasushi, Hasegawa, Tomohiko, Iizuka, Yoichi, Tonomura, Hitoshi, Terai, Hidetomi, Akeda, Koji, Seki, Shoji, Ishihara, Masayuki, Inoue, Gen, Funao, Haruki, Yoshii, Toshitaka, Kaito, Takashi, Kiyasu, Katsuhito, Tominaga, Hiroyuki, Kakutani, Kenichiro, Sakai, Daisuke, Ohba, Tetsuro, Otsuki, Bungo, Miyazaki, Masashi, Murotani, Kenta, Okada, Seiji, Imagama, Shiro, Kato, Satoshi

المصدر: Global Spine Journal ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study Design Retrospective multicenter study. Objectives The effectiveness of early surgery for cervical spinal injury (CSI) has been demonstrated. However, whether early surgery improves outcomes in the elderly remains unclear. This study investigated whether early surgery for CSI in elderly affects complication rates and neurological outcomes. Methods This retrospective multicenter study included 462 patients. We included patients with traumatic acute cervical spinal cord injury aged ≥65 years who were treated surgically, whereas patients with American Spinal Injury Association (ASIA) Impairment Scale E, those with unknown operative procedures, and those waiting for surgery for >1 month were excluded. The minimum follow-up period was 6 months. Sixty-five patients (early group, 14.1%) underwent surgical treatment within 24 hours, whereas the remaining 397 patients (85.9%) underwent surgery on a standby basis (delayed group). The propensity score-matched cohorts of 63 cases were compared. Results Patients in the early group were significantly younger, had significantly more subaxial dislocations (and fractures), tetraplegia, significantly lower ASIA motor scores, and ambulatory abilities 6 months after injury. However, no significant differences in the rate of complications, ambulatory abilities, or ASIA Impairment Scale scores 6 months after injury were observed between the matched cohorts. At 6 months after injury, 61% of the patients in the early group (25% unsupported and 36% supported) and 53% of the patients in the delayed group (34% unsupported and 19% supported) were ambulatory. Conclusions Early surgery is possible for CSI in elderly patients as the matched cohort reveals no significant difference in complication rates and neurological or ambulatory recovery between the early and delayed surgery groups.

الإتاحة: https://doi.org/10.1177/21925682241227430Test

المؤلفون: Segi, Naoki, Nakashima, Hiroaki, Machino, Masaaki, Ito, Sadayuki, Yokogawa, Noriaki, Sasagawa, Takeshi, Funayama, Toru, Eto, Fumihiko, Yamaji, Akihiro, Watanabe, Kota, Nori, Satoshi, Takeda, Kazuki, Furuya, Takeo, Yunde, Atsushi, Nakajima, Hideaki, Yamada, Tomohiro, Hasegawa, Tomohiko, Terashima, Yoshinori, Hirota, Ryosuke, Suzuki, Hidenori, Imajo, Yasuaki, Ikegami, Shota, Uehara, Masashi, Tonomura, Hitoshi, Sakata, Munehiro, Hashimoto, Ko, Onoda, Yoshito, Kawaguchi, Kenichi, Haruta, Yohei, Suzuki, Nobuyuki, Kato, Kenji, Uei, Hiroshi, Sawada, Hirokatsu, Nakanishi, Kazuo, Misaki, Kosuke, Terai, Hidetomi, Tamai, Koji, Shirasawa, Eiki, Inoue, Gen, Kakutani, Kenichiro, Kakiuchi, Yuji, Iizuka, Yoichi, Takasawa, Eiji, Akeda, Koji, Takegami, Norihiko, Kiyasu, Katsuhito, Tominaga, Hiroyuki, Tokumoto, Hiroto, Funao, Haruki, Oshima, Yasushi

المصدر: Global Spine Journal ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study Design Retrospective multicenter study. Objective The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. Methods The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score–matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. Results Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries ( P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. Conclusions The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

الإتاحة: https://doi.org/10.1177/21925682231186757Test

المؤلفون: Segi, Naoki, Nakashima, Hiroaki, Machino, Masaaki, Ito, Sadayuki, Yokogawa, Noriaki, Sasagawa, Takeshi, Funayama, Toru, Eto, Fumihiko, Watanabe, Kota, Nori, Satoshi, Furuya, Takeo, Yunde, Atsushi, Nakajima, Hideaki, Hasegawa, Tomohiko, Yamada, Tomohiro, Terashima, Yoshinori, Hirota, Ryosuke, Suzuki, Hidenori, Imajo, Yasuaki, Ikegami, Shota, Uehara, Masashi, Tonomura, Hitoshi, Sakata, Munehiro, Hashimoto, Ko, Onoda, Yoshito, Kawaguchi, Kenichi, Haruta, Yohei, Suzuki, Nobuyuki, Kato, Kenji, Uei, Hiroshi, Sawada, Hirokatsu, Nakanishi, Kazuo, Misaki, Kosuke, Terai, Hidetomi, Tamai, Koji, Inoue, Gen, Shirasawa, Eiki, Kakutani, Kenichiro, Iizuka, Yoichi, Takasawa, Eiji, Akeda, Koji, Kiyasu, Katsuhito, Tominaga, Hiroyuki, Tokumoto, Hiroto, Funao, Haruki, Oshima, Yasushi, Yoshii, Toshitaka, Kaito, Takashi, Sakai, Daisuke, Ohba, Tetsuro

المصدر: Global Spine Journal ; page 219256822311516 ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study Design Retrospective multicenter study Objectives To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan. Methods The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients’ epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019). Results Both the number of patients and number of surgical patients showed a significant increasing trend ( P < .001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P = .001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P = .006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence. Conclusions Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.

الإتاحة: https://doi.org/10.1177/21925682231151643Test

المؤلفون: Hirota, Ryosuke, Terashima, Yoshinori, Ohnishi, Hirofumi, Yamashita, Toshihiko, Yokogawa, Noriaki, Sasagawa, Takeshi, Ando, Kei, Nakashima, Hiroaki, Segi, Naoki, Funayama, Toru, Eto, Fumihiko, Yamaji, Akihiro, Watanabe, Kota, Yamane, Junichi, Takeda, Kazuki, Furuya, Takeo, Yunde, Atsushi, Nakajima, Hideaki, Yamada, Tomohiro, Hasegawa, Tomohiko, Suzuki, Hidenori, Imajo, Yasuaki, Ikegami, Shota, Uehara, Masashi, Tonomura, Hitoshi, Sakata, Munehiro, Hashimoto, Ko, Onoda, Yoshito, Kawaguchi, Kenichi, Haruta, Yohei, Suzuki, Nobuyuki, Kato, Kenji, Uei, Hiroshi, Sawada, Hirokatsu, Nakanishi, Kazuo, Misaki, Kosuke, Terai, Hidetomi, Tamai, Koji, Shirasawa, Eiki, Inoue, Gen, Kakutani, Kenichiro, Kakiuchi, Yuji, Kiyasu, Katsuhito, Tominaga, Hiroyuki, Tokumoto, Hiroto, Iizuka, Yoichi, Takasawa, Eiji, Akeda, Koji, Takegami, Norihiko, Funao, Haruki

المصدر: Global Spine Journal ; volume 14, issue 1, page 101-112 ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study design Retrospective Cohort Study Objective The purpose of this study was to investigate the prognosis of respiratory function in elderly patients with cervical spinal cord injury (SCI) and to identify predictive factors. Methods We included 1353 cases of elderly cervical SCI patients collected from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were defined as the respiratory disability group. Patients’ background characteristics, injury mechanism, injury form, neurological disability, complications, and treatment methods were compared between the disability and non-disability groups. Multiple logistic regression analysis was used to examine the independent factors. Patients who required respiratory management for 6 months or longer after injury and those who died of respiratory complications were classified into the severe disability group and were compared with minor cases who were weaned off the respirator. Results A total of 104 patients (7.8%) had impaired respiratory function. Comparisons between the disabled and non-disabled groups and between the severe and mild injury groups yielded distinct trends. In multiple logistic regression analysis, age, blood glucose level, presence of ossification of posterior longitudinal ligament (OPLL), anterior vertebral hematoma, and critical paralysis were selected as independent risk factors. Conclusion Age, OPLL, severe paralysis, anterior vertebral hematoma, hypoalbuminemia, and blood glucose level at the time of injury were independent factors for respiratory failure. Hyperglycemia may have a negative effect on respiratory function in this condition.

الإتاحة: https://doi.org/10.1177/21925682221095470Test