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Study DesignRetrospective patient data collection and investigator survey.PurposeTo investigate patterns of opioid treatment for pain caused by spinal disorders in Korea.Overview of LiteratureOpioid analgesic prescription and adequacy of consumption measures in Korea have markedly increased in the past decade, suggesting changing patterns in pain management practice; however, there is lack of integrated data specific to Korean population.MethodsPatient data were collected from medical records at 34 university hospitals in Korea. Outpatients receiving opioids for pain caused by spinal disorders were included in the study. Treatment patterns, including opioid types, doses, treatment duration, outcomes, and adverse drug reactions (ADRs), were evaluated. Investigators were interviewed on their perceptions of opioid use for spinal disorders.ResultsAmong 2,468 analyzed cases, spinal stenosis (42.8%) was the most common presentation, followed by disc herniation (24.2%) and vertebral fracture (17.5%). In addition, a greater proportion of patients experienced severe pain (73.9%) rather than moderate (19.9%) or mild (0.7%) pain. Oxycodone (51.9%) and fentanyl (50.8%) were the most frequently prescribed opioids; most patients were prescribed relatively low doses. The median duration of opioid treatment was 84 days. Pain relief was superior in patients with longer treatment duration (≥2 months) or with nociceptive pain than in those with shorter treatment duration or with neuropathic or mixed-type pain. ADRs were observed in 8.6% of cases. According to the investigators' survey, "excellent analgesic effect" was a perceived advantage of opioids, while safety concerns were a disadvantage.ConclusionsOpioid usage patterns in patients with spinal disorders are in alignment with international guidelines for spinal pain management. Future prospective studies may address the suitability of opioids for spinal pain treatment by using appropriate objective measurement tools.

Purpose. Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS) to oral tramadol/acetaminophen (TA) in Korean patients with persistent, moderate pain following spinal surgery. Methods. Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14–90 days postsurgery) were enrolled. Patients received once-weekly BTDS (n=47; 5 μg/h titrated to 20 μg/h) or twice-daily TA (n=40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets) for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL), treatment satisfaction, medication compliance, and adverse events (AEs) were assessed. Findings. At week 6, both groups reported significant pain reduction (mean NRS change: BTDS −2.02; TA −2.76, both P

Study Design A retrospective cohort study. Purpose To investigate the factors affecting symptoms in young adults with L5 spondylolysis. Overview of Literature L5 spondylolysis is a common disease. However, not all patients diagnosed with L5 spondylolysis exhibit symptoms. This study examined the factors associated with the symptoms of young adults with L5 spondylolysis. Methods The medical records of 70 young adults (mean age, 31.1 years; range, 20–39 years) with L5 spondylolysis treated at the authors’ spine center between March 2008 and February 2015 were reviewed systematically. The symptomatic group (n=46) presented with symptoms, such as back pain and/or intermittent lower limb radiating pain, whereas the asymptomatic group (n=24) did not. Age, sex, body mass index (BMI), adjacent disc degeneration, facet degeneration, and measured spino-pelvic parameters (pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, sacral inclination, and sacral table angle) were investigated with respect to the presence of symptoms. Adjacent disc degeneration was evaluated using T2-weighted sagittal magnetic resonance imaging (MRI, Pfirrmann classification), whereas facet degeneration was evaluated using T2-weighted axial MRI (Grogan classification). Results Significant differences in the BMI (p =0.032), L4–5 disc degeneration (p =0.030), L5–S1 disc degeneration (p =0.046), L4–5 facet degeneration (p =0.041), and L5–S1 facet degeneration (p =0.027) were observed between the symptomatic and asymptomatic groups. However, multivariate logistic regression analysis revealed that L5–S1 disc degeneration (p =0.033) was the only significant factor. Conclusions BMI and adjacent disc and facet degeneration may be associated with the manifestation of disease symptoms in young adults with L5 spondylolysis, and the likelihood of the patient exhibiting symptoms increases with increasing severity of L5–S1 disc degeneration.

Study Design: Retrospective study. Purpose: We report the surgical outcomes of small degenerative lumbar scoliosis (DLS) patients treated by a short-segment fusion and followed for a minimum of 5 years. Overview of Literature: Several surgical options are available for the treatment of DLS, such as decompression only, decompression plus a short-segment fusion, or decompression with a long segment fusion. Few studies have evaluated the results of a shortsegment fusion in patients with DLS over time. Methods: Seventy small DLS patients (Cobb's angle, 10°-25°) with a minimum follow-up of 5 years were treated with a shortsegment fusion between March 2004 and February 2010. The mean patient age was 71 (male:female=16:54), with a follow-up of 6.5 years (range, 5.0-11.6). The Cobb's angle, 1 and 2 segment coronal upper intervertebral angle, 1 and 2 segment sagittal upper intervertebral angle, the lumbar lordosis angle, and the C7 plumb lines (coronal and sagittal) were evaluated using simple radiographs, and visual analog scale (VAS), back pain was assessed preoperatively, immediately after surgery, and at 3, 6, and 12 months and 3 and 5 years after surgery. To identify factors influencing the radiologic progression, age, number of fusion segments, vertebral levels of fusion, body mass index, lowest instrumented vertebra (L5 or S1), bone mineral density (>-2.5, ≤-2.5), and the presence of an interbody fusion were analyzed. Results: The Cobb's angle and 1 segment coronal upper intervertebral angle showed more progression during follow up, particularly at 6 and 12 months after surgery. Clinical outcomes and radiological results were found to be significantly associated (p =0.041). No statistically significant association was found between other factors affecting radiologic progression from postoperative 6 months to 1 year. Conclusions: Radiologic variables (the Cobb's angle and coronal upper intervertebral angle-1) should be carefully considered and clinical caution exercised from 6 to 12 months after short-segment fusion in small DLS (10°-25°). [ABSTRACT FROM AUTHOR]

Purpose: The tip-apex distance (TAD) is used to predict the clinical outcome of intertrochanteric fracture fixation. We aimed to measure the changes in TAD by position and film distance using Picture Archiving and Communication System (PACS). Materials and Methods: We used a femur replica with a 10° femoral neck anteversion and a 130° neck shaft angle. Proximal femoral nail antirotation nail and a helical blade were inserted into the replica. Radiographs were taken at the neutral position and after applying 10°, 20°, 30°, 40° internal/external rotation, 10° abduction, and 10° and 40° adduction to the mechanical axis. Radiographs were taken at the replica-film distance of 10 cm and 20 cm under the same conditions, mimicking the differences in Focus-film distance (FFD), which reflect the patient's contour in clinical settings. A radiologist and an orthopedic surgeon measured the TAD twice using PACS. The average error was 2 mm (4.5%) and the standard error was ±3.04. TADs in the neutral position constituted the standard values to measure the relative errors. Results: TADs increased with an increase in the external rotation and abduction of the replica. TADs decreased with an increase in the internal rotation and adduction of the replica. For comparable measurements, relative errors were higher at FFDs of 20 cm compared to FFDs of 10 cm. Conclusion: Since the femur is internally rotated and adducted for reduction, orthopedic surgeons would assess the lag screw to be closer to the apex of femur on intraoperative radiographs. To have a correct measurement of the TAD after fixation of intertrochanteric fractures, radiographs should be taken in neutral position and measurement errors should be considered based on the patient's size. [ABSTRACT FROM AUTHOR]

Study Design: A cross-sectional study. Purpose: To explore the impact of chronic low back pain (CLBP) on individuals' quality of life; to understand current treatment practices and level of satisfaction with treatment in patients with CLBP. Overview of Literature: Assessing subjective, patient-reported outcomes such as quality of life is essential to health care research. Methods: Influences of the CLBP were analyzed via a questionnaire, which contained the character of CLBP, effect of pain management, Korean version Oswestry Disability Index (K-ODI) and Korean version of 12-item Short Form Health Survey (SF-12v2). Results: Of 3,121 subjects who responded, 67.3% had moderate to severe pain; 43.5% presented prolonged CLBP of more than two years; and 32.4% had suffered from sleep disturbance due to pain. 22.8% of the patients were not satisfied with current pain management. The mean K-ODI score was 37.63; and it was positively correlated with the mean pain intensity (r =0.6, p <0.001). The SF-12v2 result was negatively correlated with mean pain intensity (PCS: r =-0.5, p <0.001; MCS: r =-0.4, p <0.001) and also negatively correlated with the K-ODI score (PCS: r =-0.75, p <0.001; MCS: r =-0.5, p <0.001). The conformity between patients and doctors in pain assessment was fair (κ=0.2463). Conclusions: CLBP negatively affects quality of life. Of total 22.8% of the patients were not satisfied with current pain management. Such needs to be taken more seriously by doctors for improvement of satisfaction and quality of life in patients with CLBP. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze the complications, clinical outcomes, and any correlative risk factors associated with degenerative lumbar deformity surgery in elderly patients. Methods: We reviewed 78 patients who underwent posterior decompression and posterolateral fusion requiring a minimum three-level fusion for degenerative lumbar deformity associated with spinal stenosis between May 2001 and May 2006, with at least a one-year follow-up period. We assessed and compared the postoperative complications and clinical outcomes for patients aged 65 years and over (group A) and patients aged 50-64 years (group B). Risk factors that could influence complications and clinical outcome were evaluated and statistically analyzed. Results: The postoperative complication rate was not significantly different between the two age groups (53% in group A and 40% in group B); however, group A had a significantly higher frequency of minor complications than group B, especially for urinary retention and postoperative delirium. A statistical relationship between diabetes mellitus and deep wound infection, one of the major complications of degenerative lumbar deformity surgery, was observed in both group A and group B. Male sex was a risk factor for urinary retention and long operative time, and abundant blood loss was a significant risk factor for postoperative delirium in group A. Conclusion: There were no significant differences in results for degenerative lumbar deformity surgery between patients older and younger than 65 years. However, diabetes mellitus showed a significant correlation with deep wound infection, which is one of the major complications of degenerative lumbar deformity surgery, and with urinary retention and postoperative delirium, which occurred frequently in patients aged older than 65 years. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze the complications, clinical outcomes, and any correlative risk factors associated with degenerative lumbar deformity surgery in elderly patients. Methods: We reviewed 78 patients who underwent posterior decompression and posterolateral fusion requiring a minimum three-level fusion for degenerative lumbar deformity associated with spinal stenosis between May 2001 and May 2006, with at least a one-year follow-up period. We assessed and compared the postoperative complications and clinical outcomes for patients aged 65 years and over (group A) and patients aged 50-64 years (group B). Risk factors that could influence complications and clinical outcome were evaluated and statistically analyzed. Results: The postoperative complication rate was not significantly different between the two age groups (53% in group A and 40% in group B); however, group A had a significantly higher frequency of minor complications than group B, especially for urinary retention and postoperative delirium. A statistical relationship between diabetes mellitus and deep wound infection, one of the major complications of degenerative lumbar deformity surgery, was observed in both group A and group B. Male sex was a risk factor for urinary retention and long operative time, and abundant blood loss was a significant risk factor for postoperative delirium in group A. Conclusion: There were no significant differences in results for degenerative lumbar deformity surgery between patients older and younger than 65 years. However, diabetes mellitus showed a significant correlation with deep wound infection, which is one of the major complications of degenerative lumbar deformity surgery, and with urinary retention and postoperative delirium, which occurred frequently in patients aged older than 65 years. [ABSTRACT FROM AUTHOR]

We have investigated the wound-healing effects of mesenchymal stem cells (MSCs) in combination with human amniotic membrane (HAM) when grafted into full-thickness skin defects of rabbits. Five defects in each of four groups were respectively treated with HAM loaded with autologous MSCs (group A), HAM loaded with allologous MSCs (group B), HAM with injected autologous MSCs (group C), and HAM with injected allologous MSCs (group D). The size of the wounds was calculated for each group at 7, 12, and 15 days after grafting. The wounds were subsequently harvested at 25 days after grafting. Sections stained with hematoxylin and eosin were used to determine the quality of wound healing, as based on the characteristics and amount of granulated tissue in the epidermal and dermal layers. Groups A and B showed the most pronounced effect on wound closure, with statistically significant improvement in wound healing being seen on post-operative days 7, 12, and 15. Although a slight trend toward improved wound healing was seen in group A compared with group B, no statistically significant difference was found at any time point between the two groups. Histological examination of healed wounds from groups A and B showed a thin epidermis with mature differentiation and collagen bundle deposition plus recovered skin appendages in the dermal layer. In contrast, groups C and D showed thickened epidermis with immature epithelial cells and increased fibroblast proliferation with only partially recovered skin appendages in the dermal layer. Thus, the graft of HAM loaded with MSCs played an effective role during the healing of skin defects in rabbits, with no significant difference being observed in wound healing between autologous and allologous MSC transplantation. [ABSTRACT FROM AUTHOR]