Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.

STUDY DESIGN: Retrospective case series. PURPOSE: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation. OVERVIEW OF LITERATURE: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. METHODS: To obtain a relatively uniform background, patients non-surgically treated for an acute C3-4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. RESULTS: There were no significant relationships between sagittal diameter of the CSF column at the C3-4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. CONCLUSIONS: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.
Cerebrospinal Fluid ; Cervical Cord* ; Constriction, Pathologic* ; Decompression ; Dislocations* ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Canal* ; Spinal Injuries

BACKGROUND: In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. METHODS: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. RESULTS: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. CONCLUSIONS: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.
*Bone Nails ; *Dimensional Measurement Accuracy ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Hip Fractures/*surgery ; Prospective Studies ; Reproducibility of Results

BACKGROUND: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. METHODS: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. RESULTS: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. CONCLUSIONS: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.
Aged ; Aged, 80 and over ; Algorithms ; Arthroplasty, Replacement, Hip/*adverse effects ; Female ; Femoral Fractures/classification/etiology/radiography/*surgery ; Hemiarthroplasty/adverse effects ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures/classification/etiology/radiography/*surgery ; Retrospective Studies

The purpose of this study was to implement a community-based exercise program for postdischarge stroke survivors in the public health center. The subjects were fourteen male stroke survivors with chronic upper and lower limb paresis (63.0±5.9 years) . The study design was quasiexperimental, with each subject serving as his own control. All subjects have to meet following inclusion criteria: (1) first stroke resulting in hemiplegia, (2) at least 6 months post-stroke, (3) able to walk independently, and (4) free from grave aphasia, apraxia, agnosia, or disequilibrium. A 25-week (2 deek) training program consisted of a warm-up, lower and upper extremity muscle strengthening, recreational activities, walking training, and a cool down. The duration of this program is approximately 70 minutes a day. The outcome measure was the 12 functional fitness test items and questionnaire in activities parallel to daily living. Significant improvements (P<0.05) were found for handgrip strength, knee extension strength, tandem balance, standing and sitting, and timed up and go in the treatment period. However, the scores in activities parallel to daily living were not significant. These results suggest that they may attain significant functional improvements in response to implementation of a community-based exercise program. In conclusion, post-discharge stroke survivors can improve their functional fitness status by participating in a community-based exercise program.

The purpose of this study was to examine the validity of physical performance tests (test battery) for assessing functional fitness required for activities of daily life in older persons with chronic disease. This test battery consisted of 4 items: arm curl, walking around two cones, moving beans with chopsticks, and functional reach. Seventy-one persons (aged 66.7±7.8 yr) with either hemiplegia, Parkinson's disease (PD), or chronic obstructive pulmonary disease (COPD) served as subjects. There were significant differences among standard test scores in each rate of progression of the disease in all hemiplegia groups (Stages III, IV, V), and COPD groups (Stages 1, 2, 3) (Kruskal-Wallis'H=22.3 and 7.3, respectively) . In PD groups, there was no significant difference between standard scores in Stages II and III (Mann-Whitney's U=4.0) . However, the rank order correlation coefficient between the ranking in standard test score and the ranking in physical independence assessed by a medical doctor and a public health nurse was significant (ρ=0.57, P<0.05) . All tests were safely applied for all subjects. These results suggest that our test battery may be applicable to a majority of older persons with various chronic diseases. Furthermore, the variability of standard test scores was greater than the clinical subjective ratings by Stage, which suggests that such a classification may provide a better description of disease progress/functional fitness.