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Abstract Assessing intraoperative hemodynamics with Surgical Apgar Score (SAS) and preoperative nutritional status with the Controlling Nutritional Status (CONUT) score are said to be useful to predict postoperative complications in many surgical services, but little is reported in the field of spinal surgery. The purpose of this study was to assess the utility of SAS and the CONUT score for predicting the risk of major postoperative complications after spinal surgery. We included 659 people who undergone spinal surgery in our institute in eight consecutive years. The occurrence of postoperative major complications was investigated. Background clinical information, surgical information including the SAS and the CONUT score, and the length of postoperative hospital stay were collected. The risk factors of postoperative complications were assessed statistically. Complications occurred in 117 cases (17.8%). The multivariate analysis showed that history of diabetes mellitus (odds ratio [OR] 1.81: P = 0.035), coronary disease (OR 3.33; P = 0.009), American Society of Anesthesiologists Physical Status (OR 1.71; P = 0.025), use of instruments (OR 2.07; P = 0.026), operation time (OR 1.30; P

Study Design A post-hoc analysis of a prospective cohort study. Purpose This study aimed to identify factors at the time of injury associated with declining activities of daily living (ADLs) in the chronic phase of osteoporotic vertebral fractures (OVFs) managed conservatively. Overview of Literature Although a conservative approach is the treatment of choice for OVFs, ADLs do not improve or eventually decrease in some cases. However, the risk factors for ADL decline after the occurrence of OVFs, particularly the difference between those with or without initial bed rest, are unknown. Methods A total of 224 consecutive patients with OVFs aged ≥65 years who received treatment within 2 weeks after the occurrence of injury were enrolled. The patients were followed up for 6 months thereafter. The criteria for evaluating the degree of independence were applied to evaluate ADLs. Multivariable analysis with a logistic regression model was performed to evaluate the risk factors for ADL decline. Results In total, 49/224 patients (21.9%) showed a decline in ADLs. Of these, 23/116 patients (19.8%) in the rest group and 26/108 patients (24.1%) in the no-rest group experienced a decline in ADLs. In the logistic regression analyses, a diffuse low signal on T2-weighted magnetic resonance imaging (MRI) (odds ratio, 5.78; 95% confidence interval, 2.09–16.0; p=0.0007) and vertebral instability (odds ratio, 3.89; 95% confidence interval, 1.32–11.4; p=0.0135) were identified as independent factors in the rest and no-rest groups, respectively. Conclusions In patients with acute OVFs, a diffuse low signal on T2-weighted MRI and severe vertebral instability were independently associated with ADL decline in patients treated with and without initial bed rest, respectively.

Abstract Background Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Methods This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared. Results The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group. Conclusions PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.

Introduction: Lateral lumbar interbody fusion (LLIF) techniques have been extensively used in adult spinal deformity surgery. Preoperative knowledge of the optimal position of the patient on the surgical table is essential for a safe procedure. Therefore, this study aims to determine the optimal angle for positioning the patient on the surgical table during LLIF using three-dimensional computed tomography (3DCT). Methods: Data from 59 patients (2 males, 57 females, mean age 66.3±8.6 years) with adult spinal deformities treated by performing corrective spinal surgery were included in this observational retrospective study. Simulated fluoroscopic images were obtained using 3DCT images rotated from the reference position with the spinous process of S1 as the midline to the position with the spinous process in the center of the bilateral pedicle of T12-L5. The rotation angle of each vertebra was measured and defined as the optimal rotation angle (ORA). The angle that bisected the angle between the maximum and minimum ORA was defined as the optimal mean angle of the maximum and minimum ORA (OMA) and considered the optimal angle for the patient's position on the surgical table, as this position could minimize the rotation angle of the surgical table during surgery. A multiple regression analysis was performed to predict OMA. Results: Multiple regression analysis revealed the following equation: OMA=1.959+(0.238×lumbar coronal Cobb angle)+(−0.208×sagittal vertical axis). Conclusions: When the patient is placed on the surgical table by rotating them at the OMA, the rotation of the surgical table can be reduced, ensuring a safe and efficient surgical procedure.

Human gait plays a crucial role in medical diagnostics, particularly in the context of adult spinal deformities (ASD). Recent research has applied deep-learning techniques to process video data for ASD diagnosis. Although this method successfully captured dynamic postural information, it does not account for the periodicity and symmetry of motion, particularly the periodicity of gait and the inherent symmetry of locomotor postures in the gait cycle. This omission may have led to the loss of critical information necessary for an accurate diagnosis. To resolve this issue, we present a method that can effectively capture cycle and action symmetry information in motion and exploit the characteristics of gait motion. The proposed method is subsequently trained using the fused data within the deep learning model. Our experiments, performed on a video dataset consisting of 81 patients, showed that our method outperformed baseline approaches. The proposed method achieved an accuracy of 71.43, precision of 72.80, and F1 score of 71.15. The complete set of codes, models, and results can be accessed from the GitHub repository: https://github.com/ChenKaiXuSan/Skeleton_ASD_PyTorch. In this study, we present an innovative video-based approach to support clinical diagnoses of gait disorders, with a focus on periodic motion and postural symmetry. The application of deep learning in diagnostic methods has been enhanced by utilizing the kinematic properties of walking movements. The experimental results demonstrate that the proposed method can provide more accurate diagnostic results when using limited video data.

IntroductionAssessment of human gait posture can be clinically effective in diagnosing human gait deformities early in life. Currently, two methods—static and dynamic—are used to diagnose adult spinal deformity (ASD) and other spinal disorders. Full-spine lateral standing radiographs are used in the standard static method. However, this is a static assessment of joints in the standing position and does not include information on joint changes when the patient walks. Careful observation of long-distance walking can provide a dynamic assessment that reveals an uncompensated posture; however, this increases the workload of medical practitioners. A three-dimensional (3D) motion system is proposed for the dynamic method. Although the motion system successfully detected dynamic posture changes, access to the facilities was limited. Therefore, a diagnostic approach that is facility-independent, has low practice flow, and does not involve patient contact is required.MethodsWe focused on a video-based method to classify patients with spinal disorders either as ASD, or other forms of ASD. To achieve this goal, we present a video-based two-stage machine-learning method. In the first stage, deep learning methods are used to locate the patient and extract the area where the patient is located. In the second stage, a 3D CNN (convolutional neural network) device is used to capture spatial and temporal information (dynamic motion) from the extracted frames. Disease classification is performed by discerning posture and gait from the extracted frames. Model performance was assessed using the mean accuracy, F1 score, and area under the receiver operating characteristic curve (AUROC), with five-fold cross-validation. We also compared the final results with professional observations.ResultsOur experiments were conducted using a gait video dataset comprising 81 patients. The experimental results indicated that our method is effective for classifying ASD and other spinal disorders. The proposed method achieved a mean accuracy of 0.7553, an F1 score of 0.7063, and an AUROC score of 0.7864. Additionally, ablation experiments indicated the importance of the first stage (detection stage) and transfer learning of our proposed method.DiscussionThe observations from the two doctors were compared using the proposed method. The mean accuracies observed by the two doctors were 0.4815 and 0.5247, with AUROC scores of 0.5185 and 0.5463, respectively. We proved that the proposed method can achieve accurate and reliable medical testing results compared with doctors' observations using videos of 1 s duration. All our code, models, and results are available at https://github.com/ChenKaiXuSan/Walk_Video_PyTorch. The proposed framework provides a potential video-based method for improving the clinical diagnosis for ASD and non-ASD. This framework might, in turn, benefit both patients and clinicians to treat the disease quickly and directly and further reduce facility dependency and data-driven systems.

Introduction: Magnetic resonance imaging (MRI) is widely used in orthopedics, but orthopedic surgeons, including spine surgeons, do not have detailed knowledge of MRI-related accidents. We, as orthopedic surgeons, investigated the details of medical accidents related to ferromagnetic objects brought into the MRI room using a national multicenter database. Methods: We conducted an exploratory analysis of accidents involving MRI ferromagnets based on the Japanese database of adverse medical occurrences. From a total of 104,659 accident reports over nine years, 172 involving the presence of ferromagnetic objects in the MRI room were extracted and analyzed. Results: The accident reports frequently involved children and the elderly. Nurses filed the highest number of reports (44.8%) by occupation, which was more than twice as many as physicians (19.8%). The most common ferromagnetic devices brought into the MRI rooms were pacemakers (n = 22). There were also large magnetic objects such as oxygen cylinders (n = 12) and IV stands (n = 7). In the field of orthopedics, ankle weights (n = 4), pedometers (n = 3), and artificial limbs (n = 2) were brought in. “Failure to check” was the most common cause of accidents (69%). Actual harm to patients occurred in 9% of cases, with no fatalities. Conclusions: Manuals and checklists should be developed and continuous education provided to prevent accidents involving magnetic objects brought into the MR scanner room. As orthopedic surgeons, including spine surgeons, we should be cautious with emergency, geriatric, and pediatric patients because their information and medical history may not be accurate. We should not overlook equipment commonly found in orthopedic practice such as ankle weights and pedometers.

Abstract Background Spinal alignment in patients with adult spinal deformity (ASD) changes between rest and during gait. However, it remains unclear at which point the compensated walking posture breaks down and how muscles respond. This study used time-synchronized electromyography (EMG) to investigate the relationship between dynamic spinal alignment and muscle activity during maximum walking duration to reveal compensation mechanisms. Methods This study collected preoperative three-dimensional gait analysis data from patients who were candidates for corrective surgery for ASD from April 2015 to May 2019. We preoperatively obtained dynamic spinal alignment parameters from initiation to cessation of gait using a motion capture system with time-synchronized surface integrated EMG (iEMG). We compared chronological changes in dynamic spinal alignment parameters and iEMG values 1) immediately after gait initiation (first trial), 2) half of the distance walked (half trial), and 3) immediately before cessation (last trial). Results This study included 26 patients (22 women, four men) with ASD. Spinal sagittal vertical axis distance during gait (SpSVA) increased over time (first vs. half vs. last, 172.4 ± 74.8 mm vs. 179.9 ± 76.8 mm vs. 201.6 ± 83.1 mm; P

Introduction: Although lateral vertebral translation is associated with inducing curve progression and pain, no study has analyzed risk factors for lateral slip in patients with residual adolescent idiopathic scoliosis (AIS). This study aimed to investigate risk factors for lateral slip in patients with residual AIS. Methods: We included 42 preoperative patients with residual AIS with a thoracolumbar/lumbar (TL/L) curve (3 male, 39 female; age 41.9±18.2 years, TL/L Cobb angle 55.5±10.0°). All patients were >20 years and had been diagnosed with AIS during their adolescence. Lateral slip was defined as more than a 6-mm slip on coronal CT images. Results: Patients were divided into slip (n=22) and nonslip (n=20) groups. Significant differences were observed in age, TL/L Cobb angle, TL/L curve flexibility, lumbar lordosis, thoracolumbar kyphosis, apical vertebral rotation, apical vertebral translation, and L3 and L4 tilt between the groups. Multivariate analyses and receiver operating characteristic curves found that only older age was a significant risk factor for lateral slip (odds ratio: 1.214; 95% confidence interval: 1.047-1.407; P=0.010), with a cutoff value of 37 years old. Conclusions: Older age, especially >37 years, is a risk factor for lateral slip in patients with residual AIS. These findings suggest that surgery for residual AIS should be considered before patients are in their mid-30s to avoid lateral translation.

Introduction: Although strict compliance with brace wearing is important for patients with scoliosis, no study has analyzed the most ideal conditions for temperature logger accuracy. We evaluated the optimal brace position and threshold temperature for the logger and determined the reliability of its measurements in patients with scoliosis. Methods: Five temperature loggers were embedded into holes generated at five different brace positions (right scapula, right chest, left chest, lumbar, and abdomen) within the brace. We compared measurement errors at each position using different threshold temperatures to determine the ideal anatomical position and threshold temperature. Under the ideal conditions determined, we calculated the reliability of the temperature logger readings in three healthy participants. Results: Measurement errors (i.e., differences between the actual and logger-recorded brace wearing times) were the lowest at the 28°C and 30°C threshold temperatures when the logger was positioned at the left chest and at 30°C at the abdomen. Among these three temperature/position combinations, we considered the abdomen to be the least affected by the shape of the brace; thus, the placement of the temperature logger at the abdomen using a threshold temperature of 30°C was the most ideal condition. Conclusions: The placement of the temperature logger at the abdomen using a threshold temperature of 30°C was the most ideal condition, with the reliability of the logger being 97.9%±0.9%. This information might be useful for scoliosis management teams, and this temperature logger provides a valuable clinical tool.