Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study
verfasst von:
S. Richner-Wunderlin, A. F. Mannion, A. Vila-Casademunt, F. Pellise, M. Serra-Burriel, B. Seifert, E. Aghayev, E. Acaroglu, A. Alanay, F. J. S. Pérez-Grueso, I. Obeid, F. Kleinstück, European Spine Study Group (ESSG)
The aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment.
Methods
Baseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being “indication for surgery” and baseline parameters as independent variables.
Results
In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02–1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95–0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32–0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01–1.05), lower age (OR 0.96 95% CI 0.95–0.98), prior decompression (OR 3.76 95% CI 1.00–14.08), prior infiltration (OR 2.23 95% CI 1.12–4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11–3.54) and sagittal subluxation (OR 4.38 95% CI 1.61–11.95).
Conclusion
Specific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
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Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study
verfasst von
S. Richner-Wunderlin A. F. Mannion A. Vila-Casademunt F. Pellise M. Serra-Burriel B. Seifert E. Aghayev E. Acaroglu A. Alanay F. J. S. Pérez-Grueso I. Obeid F. Kleinstück European Spine Study Group (ESSG)
Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.
Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.
Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.
Update Orthopädie und Unfallchirurgie
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