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Wolfgang Hitzl,Eugen Trinka,Leonard Seyfang,Sebastian Mutzenbach,Katharina Stadler,Slaven Pikija,Monika Killer,Erasmia Broussalis 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4
Background and Purpose This study analyzed the number of patients with ischemic strokes recorded in the Austrian Stroke-Unit Registry with the aim of projecting this number from 2012 to 2075 and to highlight that the Austrian health system will face a dramatic in¬crease in older patients within the next few decades. Methods Current demographic information was obtained from EUROSTAT, and informa¬tion on age- and sex-stratified 1-year incidence rates of ischemic stroke were obtained from the Austrian Stroke-Unit Registry. Sensitivity analysis was performed by analyzing the pro¬jections based on predicted ageing, main, and growth population scenarios, and with stratifi¬cation by age and gender. Results The total number of ischemic strokes recorded in the Austrian Stroke-Unit Regis¬try was 8,690 in 2012 and is expected to increase to 15,826, 15,626, or 18,134 in 2075 accord¬ing to the ageing, main, and growth scenarios, respectively. The corresponding numbers of patients are projected to increase or decrease within different age strata as follows (100%=num¬ber of registered ischemic strokes in 2012): 0–40 years, 100%/99% (males/females); 40–50 years, 83%/83%; 50–60 years, 98%/97%; 60–70 years, 126%/119%; 70–80 years, 159%/139%; 80–90 years, 307%/199%; and 90+ years, 894%/413%. Conclusions The ageing population in Austria will result in the number of patients increasing considerably from 2012 to 2075, to 182%, 180%, or 208% (relative to 100% in 2012) according to the ageing, main, and growth scenarios, respectively; the corresponding value among those aged 80+ years is 315%, 290%, or 347%. These figures demonstrated the importance of improving pri¬mary preventive measures. The results of this study should provide a basis for discussions among health-care professionals and economists to face the future large financial burden of ischemic stroke on the Austrian health system.
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Juliane Zenner,Wolfgang Hitzl,Michael Mayer,Heiko Koller 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1
Study Design: This was a prospective randomized comparative study. Purpose: The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. Overview of Literature: Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported. Methods: Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7–10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented. Results: Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all p >0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p =0.004) and day 2 (p =0.005). Conclusions: VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.
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Koller Juliane,Bismarck Carsten,Krebs Sona,Hitzl Wolfgang,Mayer Michael,Koller Heiko 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2
Study Design: Cross-sectional population-based study.Purpose: The study objective was to evaluate the coexistence of neck- and shoulder-disability, to establish normative scores for Neck Disability Index (NDI), Visual Analog Scale (VAS)-neck, VAS-arm, Quick Disability of Shoulder and Hand (Quick-DASH), and modified Constant score (mConstant score), and to determine the influence of psychological distress (Hospital Anxiety and Depression Scale [HADS]) on the disability measures. The authors also investigated the distribution of dysphagia across the population and its relation to the NDI scores.Overview of Literature: Several factors can adversely influence the clinical outcomes after cervical surgeries. The interaction of neck and shoulder disability in the perspective of psychological distress is not well understood.Methods: Prospective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities.Results: Mean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, QuickDASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (<i>p</i><0.0001, <i>r</i>=0.3 to <i>r</i>=0.5). However, correlations between neck (NDI%, neck VAS score) and shoulder disability (mConstant score, arm VAS score, Quick-DASH) were stronger (<i>p</i><0.0001, <i>r</i>=0.5 to <i>r</i>=0.6). A body mass index >35 kg/m<sup>2</sup> influenced shoulder-disability (<i>p</i><0.005) and psychological distress (HADS-D score, <i>p</i><0.00001). Limited neck rotation was present in those with higher age, psychological distress, neck and shoulder disability (<i>p</i><0.001).Conclusions: Normative scores for neck and shoulder disability were established. The outcomes of cervical spine surgery can be normalized to these results. A better understanding of the interdependencies of neck and shoulder disability and psychological distress would enable superior decision-making and patient counseling.
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