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- 저자 : Comron Saifi (검색결과 2 건)
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Cement Augmentation of Vertebral Compression Fractures May Be Safely Considered in the Very Elderly
Anoop R. Galivanche,Courtney Toombs,Murillo Adrados,Wyatt B. David,Rohil Malpani,Comron Saifi,Peter G. Whang,Jonathan N. Grauer,Arya G. Varthi 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: The objective of the current study was to perform a retrospective review of a national database to assess the safety of cement augmentation for vertebral compression fractures in geriatric populations in varying age categories. Methods: The 2005–2016 National Surgical Quality Improvement Program databases were queried to identify patients undergoing kyphoplasty or vertebroplasty in the following age categories: 60–69, 70–79, 80–89, and 90+ years old. Demographic variables, comorbidity status, procedure type, provider specialty, inpatient/outpatient status, number of procedure levels, and periprocedure complications were compared between age categories using chi-square analysis. Multivariate logistic regressions controlling for patient and procedural variables were then performed to assess the relative periprocedure risks of adverse outcomes of patients in the different age categories relative to those who were 60–69 years old. Results: For the 60–69, 70–79, 80–89, and 90+ years old cohorts, 486, 822, 937, and 215 patients were identified, respectively. After controlling for patient and procedural variables, 30-day any adverse events, serious adverse events, reoperation, readmission, and mortality were not different for the respective age categories. Cases in the 80- to 89-year-old cohort were at increased risk of minor adverse events compared to cases in the 60- to 69-year-old cohort. Conclusion: As the population ages, cement augmentation is being considered as a treatment for vertebral compression fractures in increasingly older patients. These results suggest that even the very elderly may be appropriately considered for these procedures (level of evidence: 3).
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Philip K. Louie,Andrew C. Sexton,Danel D. Bohl,Ehsan Tabaraee,Steven M. Presciutti,Benjamin C. Mayo,Justin C. Paul,Comron Saifi,Howard S. An 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
Objective: To determine the risk factors associated with radiographic changes and clinical outcomes following 3-level anterior cervical discectomy and fusion (ACDF) using rigidplate constructs and cortico-cancellous allograft. ACDF has demonstrated efficacy for treatment of multilevel degenerative cervical conditions, but current data exists in small heterogeneous forms. Methods: A retrospective review included 98 patients with primary 3-level ACDF surgery at one institution from 2008 to 2013 with minimum 1-year follow-up. Cervical sagittal vertical axis (SVA), segmental height, fusion, and lordosis radiographs were measured preoperatively and at 2 postoperative periods. Results: Rates of asymptomatic pseudarthroses and total reoperations were 18% and 4%, respectively. Results demonstrated immediate improvements in cervical lordosis (5.5°, p<0.01) and segmental height (5.0-mm increase, p<0.01) with little changes in the cervical SVA (3.2-mm increase, p<0.01). The segmental height decreased from immediate postoperative period to final follow-up (1.7-mm decrease, p<0.01). Older age was protective against radiolucent lines (p<0.05). Patient-reported outcomes significantly improved following surgery (p<0.01). Current smoking status and diagnosis of diabetes mellitus had no impact on radiographic or clinical outcomes. Risk factors were not identified for the 5 reoperations (4%). Conclusion: Three-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anteriorposterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient-reported outcomes show significant improvements.
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