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Untreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems.

Introduction Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality. Aim of this study is to construct a statistical decision analysis (DA) model to identify the optimum overall treatment in ASD.Material and Methods From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis.Results 432 patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1%) were found to be improved (a decrease in ODI > 8 points), 225 (52.1%) unchanged (−8 > ODI > 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2%) versus NS (9.7%) (Table 1a). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final outcomes in the NS group, although this group had also started with higher QALE. There were improvements in overall QALE in both groups but this was significant only in the surgical group (Table 1b). In addition, in the subgroup of patients with significant baseline disability (ODI > 25) surgery appeared to yield marginally better final QALE (Table 1c).Conclusion This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6%) QALE compared with surgery, probably secondary to a higher baseline QALE; except in patients with significant disability at baseline. On the other hand, surgery provides a significantly higher increase in QALE and chances of improvement at 1st year are significantly lower with NS treatment.

Introduction Adult spinal deformity (ASD) may be classified as idiopathic (I) or degenerative (D) (or other) based on classifier's perception, the reliability of and factors inherent to which remain unknown. Aim of study is to evaluate the inter and intraobserver reliability of surgeons' perception in differentiating I from D ASD and to identify the determinants of it.Material and Methods From a multicentric prospective database, 179 patients were identified with the diagnosis of I (n= 103) or D (n= 76); no previous surgery; and a lumbar coronal curve > 20°. Standing AP and lateral X-Rays were sent to five experienced spine surgeons to be identified as D or I (or other); followed by a second round after reshuffling. Weighted Kappa statistics was used, after which the patients were stratified by number of agreements as perfect (10/10) and very good (≥8/10); these were further compared for additional radiological parameters.Results Four observers completed both rounds while the 5th did only the first (a total of 10 observations/pt including the record). Agreement levels were moderate to good for intra but fair to moderate for interobserver comparisons (Table 1). There were 42 perfect and 80 with very good agreements for I patients but only 6 perfect and 17 very good agreements for D. Upon comparison of these, it was seen that they were different for some coronal parameters such as lumbar Cobb angle (larger in I, p< 0.001), CSVL modifier (C more common in I, p= 0.007) and presence of rotatory subluxation (less common in D, p= 0.017) but very different for sagittal parameters (lumbar lordosis, sagittal vertical axis, T2-sagittal tilt, pelvic tilt, sacral slope and global tilt; increased sagittal imbalance in D, all p≤0.001).Conclusion Surgeons in this study demonstrated reasonable intraobserver agreement but only fair agreement amongst them. These findings suggest that especially in patients with significant coronal curves, determination of curve etiology with only radiological data may not be accurate. In patients with good agreement, the most consistent radiologic determinant appeared to be the presence of sagittal imbalance.

Introduction As surgical decision-making and preoperative planning for adult spinal deformity (ASD) need strongly be interrelated to health related quality of life (HRQOL), there are multiple studies focusing on factors with an impact on it. Based on the general perception of association between the treatment results and the psychological condition of patients with ASD, analyzing the factors governing the baseline psychological status of this group may be worthwhile. Aim of study is to develop an understanding of which factors have a greater impact on the SF-36 mental component score (MCS) and to establish a hierarchy of these parameters through multiple regression analysis.Material and Methods Prospectively collected data from a multicentric adult deformity database was analyzed using multiple regression analysis with SF-36 MCS designated as the dependent variable and demographic, radiological and the HRQOL parameters as independent variables. The regression model was started with a correlation analysis between SF-36 MCS and all independent variables then conducted by introducing the variables with the highest correlation with SF-36 MCS, sequentially.Results A total of 229 patients (181♀, 47♂) with a mean age of 49.4 (18– 85) years, were analyzed. A strong correlation between SF-36 MCS and Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI), gender, and diagnosis were found (p< 0.05). The distribution graph and results of regression analysis are summarized in Fig. 1. The overall R2 of this model was 0.254 (p< 0.001).Conclusion This study has demonstrated that, among the evaluated parameters, the overall HRQOL (SRS-22 and ODI) as well as thoracic kyphosis (TK) and gender are the most important parameters affecting the mental component summary of SF-36 in ASD population. Although the strong association with SRS-22 and/or ODI was to be expected, less strong associations with TK (as a token of appearance?) and gender (due to different mechanisms of coping with disability?) were less expected and may warrant further consideration in our understanding of the population of ASD.

Introduction Treatment of adult spinal deformity (ASD) is known to be associated with a fairly high rate of complications whereas the impact of these complications on treatment outcomes is less well known. Aim of this study is to analyze the impact of treatment complications on outcomes in ASD using a decision analysis (DA) model.Material and Methods From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and non-life threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement (decrease in ODI > 8pts), no change and deterioration (increase in ODI > 8pts). Death/complete paralysis was considered as a separate category.Results All 535 patients (371 NS, 164 S) could be analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment was significantly more prone to complications (31.7% versus 11.1%, p< 0.001) (Table 1 a). On the other hand, presence of complications did not necessarily decrease the chances of improvement, surgical patients tending to rate better in this respect (Table 1b). Likewise, QALE was not particularly affected by the presence or absence of complications regardless of the type of treatment (Table 1c).Conclusion This study has demonstrated that surgical treatment of ASD is more likely to cause complications compared with non-surgical treatment. On the other hand, presence of complications neither has a negative impact on the likelihood of clinical improvement nor affects the QALE at the first year detrimentally.