The spine journal : official journal of the North American Spine Society
-
Multicenter Study Observational Study
Psychometric properties of the 30-m walking test in patients with degenerative cervical myelopathy: results from two prospective multicenter cohort studies.
The timed 30-m walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated. ⋯ The 30MWT shows high test-retest reliability and good divergent and convergent validity. It is responsive to change only in patients with more severe myelopathy. The 30MWT is a simple, quick, and affordable test, and should be used as an ancillary test to evaluate gait parameters in patients with DCM.
-
Timely interpretation of computed tomography (CT) scans is of paramount importance in diagnosing and managing spinal column fractures, which can be devastating. Out-of-hospital, on-call spine surgeons are often asked to evaluate CT scans of patients who have sustained trauma to the thoracolumbar spine to make diagnosis and to determine the appropriate course of urgent treatment. Capturing radiographic scans and video clips from computer screens and sending them as instant messages have become common means of communication between physicians, aiding in triaging and transfer decision-making in orthopedic and neurosurgical emergencies. ⋯ Intraobserver agreement for determining fracture level was near perfect (κ=0.94). Intraobserver agreement for AO classification, proposed treatment, neural canal penetration, and Denis classification were substantial (κ values, 0.75, 0.73, 0.71, and 0.69, respectively). Intraobserver agreement for loss of vertebral height and kyphosis were moderate (κ values, 0.55 and 0.45, respectively) CONCLUSIONS: Video clips of CT scans can be readily captured by a smartphone from a workstation-based PACS and then transmitted by use of the WhatsApp instant messaging application. Diagnosing, classifying, and proposing treatment of fractures of the thoracic and lumbar spine can be made with equal reliability by evaluating video clips of CT scans transmitted to a smartphone or by the standard method of viewing the CT scan on a workstation-based PACS. Evaluating video clips of CT scans transmitted to a smartphone is a readily accessible, simple, and inexpensive method. We believe that it can be reliably used for consultations between the emergency physicians or orthopedic or neurosurgical residents with offsite, on-call specialists. It might also enable rural orcommunity emergency department physicians to communicate more efficiently and effectively with surgeons in tertiary referral centers.
-
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist. ⋯ This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively.
-
Lumbar spinal stenosis (LSS) can hinder a patient's physical activity, which in turn can impair glucose tolerance and body weight regulation in patients with type 2 diabetes mellitus (DM-2). Therefore, successful lumbar surgery could facilitate glycemic control and body weight regulation. ⋯ The present study demonstrates that in patients with DM-2 and LSS, successful lumbar surgery may facilitate glycemic control by enabling an increase in the patient's level of physical activity. Additionally, it could help reduce body weight in overweight (BMI>25) patients with DM-2 and LSS.
-
Comparative Study
Biochemical validity of imaging techniques (X-ray, MRI, and dGEMRIC) in degenerative disc disease of the human cervical spine-an in vivo study.
On a molecular level, maturation or degeneration of human intervertebral disc is among others expressed by the content of glycosaminoglycans (GAGs). According to the degenerative status, the disc content can differ in nucleus pulposus (NP) and annulus fibrosus (AF), respectively. Research in this area was conducted mostly on postmortem samples. Although several radiological classification systems exist, none includes biochemical features. Therefore, we focused our in vivo study on a widely spread and less expensive imaging technique for the cervical spine and the correlation of radiological patterns to biochemical equivalents in the intervertebral discs. ⋯ The GAG content in human cervical discs can be detected in vivo and is subject to a significantly (p<.05) region-specific pattern (AF vs. NP; anterior vs. posterior in the AF). Up to the levels of AF and NP, this is reproducible in MRI in dGEMRIC technique, but not in X-ray or standard MRI sequences. Potentially, the MRI in dGEMRIC technique can be used as a non-invasive in vivo indicator for disc degeneration in the cervical spine.