Search

Abstract Background Osteoporotic vertebral compression fractures (OVF) are prevalent and substantially impact healthcare systems and patients’ quality of life. The osteoporotic fracture treatment score (OF score), developed by the German Society of Orthopedics and Trauma (DGOU), guides surgical decisions, but its reliability and validity are underexplored. This study assessed the OF score’s inter- and intraobserver reliability, validated its treatment recommendations, and investigated intermediate outcomes of different DGOU-recommended surgical strategies for OVF. Methods A retrospective cohort study was conducted. Inter- and intraobserver reliability of the OF score and its subcomponents were analyzed using clinical and radiographic data. Validity was assessed by comparing the OF score’s recommended treatments with actual treatments received. Outcomes at the final follow-up were back pain visual analog scale, Oswestry Disability Index, EQ-VAS, EQ-5D-5 L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included. Results A total of 157 patients (84.7% female; mean age 74.2 ± 10.5 years) were evaluated. The most frequent osteoporotic fracture (OF) types were OF4 (49.0%) and OF3 (40.8%). The OF score demonstrated good interobserver reliability (ICC = 0.77, 95% CI: 0.65–0.86) and intraobserver reliability (ICC = 0.83, 95% CI: 0.72–0.90). Kappa values for subcomponents ranged from 0.57 to 0.89. Excluding patients with indeterminate recommendations (OF score = 6), 82.9% received treatments concordant with OF score recommendations. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 (95% CI: 0.67–0.86); an OF score cutoff > 6.5 predicted actual treatment with 87.9% sensitivity and 61.0% specificity. All surgical treatments showed comparable improvements in clinical outcomes. However, patients treated with stand-alone cement augmentation (CA) had less local kyphotic angle correction (P = 0.004) and greater postoperative kyphotic progression (P

Abstract Study design Retrospective study. Objectives To perform effectiveness and economic analyses using data from a retrospective study of patients who underwent XLIF surgery using tricalcium phosphate combined with iliac bone graft (TCP + IBG) or BMP-2 in Thailand. Methods Data were collected from retrospective review of the medical charts and the spine registry of Siriraj Hospital, Bangkok, Thailand. The patients were divided into two groups (TCP + IBG group and BMP-2 group). Demographic, perioperative data, radiographic, clinical results, and quality of life related to health were collected and analyzed at 2-year follow-up. All economic data were collected during the perioperative period and presented as total charge, bone graft, implant/instrumentation, operative service, surgical supply, transfusion, medication, anesthesia, laboratory, and physical therapy. Results Twenty-five TCP + IBG and 30 BMP-2 patients with spondylolisthesis and spinal stenosis as primary diagnosis were included. There were no significant differences in all demographic parameters (gender, age, underlying disease, diagnosis, and level of spine) between these two groups. During the perioperative period, the TCP + IBG group had more mean blood loss and more postoperative complications compared to the BMP-2 group. At 2 years of follow-up, there were no significant differences between the radiographic and clinical outcomes of the TCP + IBG and BMP-2 groups. The fusion rate for TCP + IBG and BMP-2 at 2 years of follow-up was 80% and 96.7%, respectively, and no statistically significant differences were observed. All clinical outcomes (Utility, Oswestry Disability Index, and EuroQol Visual Analog Scale) at 2-year follow-up improved significantly compared to preoperative outcomes, but there were no significant differences between the TCP + IBG and BMP-2 groups, either at preoperatively or at 2-year follow-up. The total charge of TCP + IBG was statistically significantly lower than that of BMP-2. Furthermore, the charges of TCP + IBG and BMP-2 during the perioperative period in Thailand were up to three times less than those in the United States. Conclusions Using TCP + IBG as a standalone bone substitution for XLIF surgery with additional posterior instrumentation resulted in significantly lower direct medical charge compared to those using BMP-2 in the perioperative period. However, we could not detect a difference in the long-term radiographic and clinical outcomes of patients with TCP + IBG and BMP-2. These suggest that TCP + IBG may be a valuable alterative bone graft, especially in low- and middle-income countries.

Abstract Introduction Chordomas are rare, locally aggressive tumors that often occur in the axial spine, especially in the sacrum. The treatment of chordomas located in the upper cervical spine is challenging. En bloc resection is the preferred surgical option for total tumor removal. Case presentation We report the case of a C2 chordoma in a 47-year-old Thai woman. She was treated with a two-stage, anterior–posterior, C2 total spondylectomy with titanium mesh cage reconstruction and radiotherapy. The first stage involved posterior stabilization from the occiput to C5, a total laminectomy, and removal of the posterior rings of the bilateral foramen transversarium to preserve the bilateral vertebral arteries. The second stage comprised a transoral mandibular split with en bloc resection of C2, followed by titanium mesh cage reconstruction and kick-off anterior cervical plating. At the 5 year follow-up, no tumor recurrence was identified on magnetic resonance imaging. The patient had no neurological deficits but still had minor complications from the anterior transoral mandibular split. Conclusions Excellent midterm results were obtained using a transoral mandibular split with reconstruction and posterior spinal fusion from the occiput to the lower cervical spine coupled with adjuvant radiotherapy. We recommend this approach as the treatment of choice for chordoma in the upper cervical spine.

Abstract Background Lumbar interbody fusion techniques treat degenerative lumbar diseases effectively. Minimally invasive lateral lumbar interbody fusion (LLIF) decreases soft tissue disruption and accelerates recovery better than standard open posterior lumbar interbody fusion (PLIF). However, the material cost of LLIF is high, especially in Thailand. The cost-effectiveness of LLIF and PLIF in developing countries is unclear. This study compared the cost-utility and clinical outcomes of LLIF and PLIF in Thailand. Methods Data from patients with lumbar spondylosis who underwent single-level LLIF and PLIF between 2014 and 2020 were retrospectively reviewed. Preoperative and 1-year follow-up EuroQol-5D-5L and healthcare costs were collected. A cost-utility analysis with a lifetime time horizon was performed using a societal perspective. Outcomes are reported as the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-year (QALY) gained. A Thai willingness-to-pay threshold of 5003 US dollars (USD) per QALY gained was used. Results The 136 enrolled patients had a mean age of 62.26 ± 11.66 years. Fifty-nine patients underwent LLIF, while 77 underwent PLIF. The PLIF group experienced greater estimated blood loss (458.96 vs 167.03 ml; P

Study design: Retrospective cohort study. Purpose: Spondylodiscitis is the most common infectious disease of the spine which can be treated either conservative or surgery. Nowadays, there are only a few studies on radiographic outcomes. The purpose of this study was to investigate the long-term radiographic outcomes of conservative treatment compared with surgical treatment in single-level infective spondylodiscitis patients. Methods: Patients diagnosed with single-level infective spondylodiscitis in lumbar vertebrae during July 2009 to September 2019 were eligible for inclusion. Radiographic evaluation comprising lumbar lordotic angle, segmental kyphotic angle, and foraminal height of was performed on lumbar lateral view before treatment and at the 1-year follow-up. Results: A total of 116 patients (mean age; 60 years; 53 males) were included. Except for length of hospital stay, which was significantly longer in the surgical group, there were no significant differences for any of the other demographic or clinical characteristics between groups. All pre-treatment radiographic parameters in the surgical group were worse than in the conservative group. At the 1-year follow-up, conservative treatment patients demonstrated significantly worse segmental kyphosis (p ​

Objective: When patients with chronic osteoarthritis (OA) knee pain do not respond to conservative treatment and are not suitable for knee arthroplasty, radiofrequency ablation (RFA) of the genicular nerve is probably an alternative treatment. This study aimed to evaluate the efficacy and safety of genicular nerve ablation in severe osteoarthritic knee pain patients. Materials and Methods: Patients with severe chronic OA knee pain were recruited and performed a genicular nerve block (GNB). The patients’ demographic data, numerical rating scale (NRS) at rest and on movement, Thai Oxford knee score (Thai OKS), Thai knee injury and osteoarthritis outcome score physical function short form (Thai KOOS-PS), timed up and go test, brief pain inventory, fall evaluation, and EuroQol 5D-5L were recorded. For the positive block patients (≥50% pain relief for 24 hours), genicular nerve RFA was performed under fluoroscopic or ultrasound guidance. All patients were followed up at the 1st, 3rd, 6th, 9th and 12th months. Results: 21 patients were included in the study, but only 17 were completely followed up for 12 months. At the 12th month, genicular nerve RFA reduced the mean NRS on movement from 7.9±1.6 to 4.0±2.6 (p=0.005), improved knee function (Thai OKS from 18.8±5.3 to 28.5±10.1; p=0.006), but did not significantly improve quality of life (EuroQol-5D-5L from 0.43±0.20 to 0.69±0.33; p=0.130). No adverse events were observed. Conclusion: Genicular nerve radiofrequency ablation in severe chronic OA knee patients demonstrated significant pain relief and functional improvement for up to 12 months without serious adverse events.

Abstract Background It has been well established that biofilm formation on orthopaedic implants is a critical event in the pathogenesis of orthopaedic infections, yet the natural history of this process with respect to bacterial adhesion, proliferation, and glycocalyx matrix production remains poorly understood. Moreover, there are no quantitative methods yet available to assess the differences in biofilm formation between different bacterial strains or implant materials. Consequently, this study aimed to investigate the natural history of S. aureus in in vitro biofilm formation in human plasma media using a flow chamber system. Bioluminescent S. aureus strains were used to better understand the bacterial growth and biofilm formation on orthopaedic materials. Also, the effects of human plasma media were assessed by loading the chamber with Tryptic Soy Broth with 10% human plasma (TSB + HP). Results Scanning electron microscopy (SEM) was utilized to assess the morphological appearance of the biofilms, revealing that S. aureus inoculation was required for biofilm formation, and that the phenotypes of biofilm production after 24 h inoculation with three tested strains (SH1000, UAMS-1, and USA300) were markedly different depending on the culture medium. Time course study of the bioluminescence intensity (BLI) and biofilm production on the implants due to the UAMS-1 and USA300 strains revealed different characteristics, whereby UAMS-1 showed increasing BLI and biofilm growth until peaking at 9 h, while USA300 showed a rapid increase in BLI and biofilm formation at 6 h. The kinetics of biofilm formation for both UAMS-1 and USA300 were also supported and confirmed by qRT-PCR analysis of the 16S rRNA gene. Biofilms grown in our flow chamber in the plasma media were also demonstrated to involve an upregulation of the biofilm-forming-related genes icaA, fnbA, and alt. The BLI and SEM results from K-wire experiments revealed that the in vitro growth and biofilm formation by UAMS-1 and USA300 on stainless-steel and titanium surfaces were virtually identical. Conclusion We demonstrated a novel in vitro model for S. aureus biofilm formation with quantitative BLI and SEM outcome measures, and then used this model to demonstrate the presence of strain-specific phenotypes and its potential use to evaluate anti-microbial surfaces.

Objective: To analyze the median survival time of and prognostic factors for metastatic epidural spinal cord compression (MESCC) secondary to preoperative unknown primary tumor (pre-op UPT) compared to MESCC secondary to preoperative known primary tumor (pre-op KPT). Materials and Methods: This retrospective cohort study reviewed all consecutive MESCC patients who underwent surgical decompression with or without stabilization within 72 hours of admission during 2010 to 2016. Survival was compared between the pre-op UPT and pre-op KPT groups, and preoperative and postoperative prognostic factors for survival were analyzed. Results: A total of 169 patients (pre-op UPT: 51, and pre-op KPT: 118) were enrolled. The survival rate at 3, 6, and 12 months was 84.3%, 58.8%, and 47.1% in the pre-op UPT group, and 72.0%, 48.3%, and 34.7% in the pre-op KPT group, respectively. The median survival time secondary to lung cancer was significantly longer in the pre-op UPT group (6.0±1.4 months) than in the pre-op KPT group (3.6±0.2 months) (p=0.031). Multivariate analysis revealed survival time to be influenced by preoperative known or unknown primary tumor status, revised Tokuhashi score, the adjuvant therapy, and postoperative complications, including myocardial infarction, gastrointestinal bleeding, and urinary tract infection. Conclusion: MESCC secondary to preoperative unknown primary tumor patients who had the clinical presentation with acute progressive neurological deficits who need urgency spine surgery has comparable survival to MESCCsecondary to preoperative known primary tumors.

Poor nutritional status which is found in many hip fracture patients may be one explanation for their increased morbidity and mortality. A retrospective study was performed to study the nutritional profile in Thai patients with hip fracture who had been admitted to Siriraj Hospital from January 2005 to March 2006. The parameter that was used to determine the nutritional profile was the level of albumin. The nutritional differences in hip fractures were assessed. The incidence of protein depletion was significantly higher in patients with trochanteric hip fractures than patients with intracapsular hip fractures. However, the average serum albumin level was significantly lower in patients with the intracapsular fractures than patients with trochanteric fractures. In addition, we found that a moderate level of malnutrition was related to post-operative complications in patients with the intracapsular hip fractures. Therefore, the higher complication rates in patients with intracapsular fractures than in patients with trochanteric fractures may be caused by the poorer nutritional status.

Objective: The aim of this study was to present our data comparing clinical results between arthroscopic debridement and open arthrotomy for the treatment of septic arthritis of the knee. Methods: The study was carried out as a retrospective study and was performed in 77 patients who had primary septic arthritis of their knees and were treated at the Department of Orthropaedic Surgery, Faculty of Medicine Siriraj Hospital during 2002 to 2111. Medical records of patients’ demographic data and clinical findings and the information of all investigation were reviewed. The early results of the treatment between the patients who underwent arthroscopic debridement and the patients who underwent arthrotomy were analyzed. Results: There were 38 males and 39 females with an average age of 57.7±16.0 years. Thirty three patients were in the arthroscopic group and 44 patients were in the open arthrotomy group. No differences between the two groups were observed with regard to patients’ characteristics, demographics data, clinical presentation and laboratory investigations. The most common organisms were Streptococcus spp. (39%) and Staphylococcus aureus (37%). Less blood loss (p < 0.01) and fewer post-operative complications (p < 0.05) were observed in the arthroscopic debridement group compared to the open arthrotomy group, even though arthroscopic surgery required a longer operative time (p < 0.01). However, there was no difference for the length of the hospital stay between the two groups (p > 0.05). Conclusion: Arthroscopic debridement provided good results which were similar to open arthrotomy with less immediate complications.

Background: Nowadays, minimally invasive lateral lumbar interbody fusion (LLIF) is used to treat degenerative lumbar spine disease. Many studies have proven that LLIF results in less soft tissue destruction and rapid recovery compared with open posterior lumbar interbody fusion (PLIF). Our recent cost-utility study demonstrated that LLIF was not cost-effective according to the Thai willingness-to-pay threshold, primarily due to the utilization of an expensive bone substitute: bone morphogenetic protein 2. Therefore, this study was designed to use less expensive tricalcium phosphate combined with iliac bone graft (TCP + IBG) as a bone substitute and compare cost-utility analysis and clinical outcomes of PLIF in Thailand. Methods: All clinical and radiographic outcomes of patients who underwent single-level LLIF using TCP + IBG and PLIF were retrospectively collected. Preoperative and 2-year follow-up quality of life from EuroQol-5 Dimensions-5 Levels and health care cost were reviewed. A cost-utility analysis was conducted using a Markov model with a lifetime horizon and a societal perspective. Results: All enrolled patients were categorized into an LLIF group (n = 30) and a PLIF group (n = 50). All radiographic results (lumbar lordosis, foraminal height, and disc height) were improved at 2 years of follow-up in both groups (P < 0.001); however, the LLIF group had a dramatic significant improvement in all radiographic parameters compared with the PLIF group (P < 0.05). The fusion rate for LLIF (83.3%) and PLIF (84%) was similar and had no statistical significance. All health-related quality of life (Oswestry Disability Index, utility, and EuroQol Visual Analog Scale) significantly improved compared with preoperative scores (P < 0.001), but there were no significant differences between the LLIF and PLIF groups (P > 0.05). The total lifetime cost of LLIF was less than that of PLIF (15,355 vs 16,500 USD). Compared with PLIF, LLIF was cost-effective according to the Thai willingness-to-pay threshold, with a net monetary benefit of 539.76 USD. Conclusion: LLIF with TCP + IBG demonstrated excellent radiographic and comparable clinical health-related outcomes compared with PLIF. In economic evaluation, the total lifetime cost was lower in LLIF with TCP + IBG than in PLIF. Furthermore, LLIF with TCP + IBG was cost-effective compared with PLIF according to the context of Thailand. Clinical Relevance: LLIF with less expensive TCP + IBG as bone graft results in better clinical and radiographic outcomes, less lifetime cost, and cost-effectiveness compared with PLIF. This suggests that LLIF with TCP + IBG could be utilized in lower- and middle-income countries for treating patients with degenerative disc disease. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]