Ekkapoj Korwutthikulrangsri

Background: Frailty among surgical patients correlates with the risks of adverse outcomes, including postoperative complications, extended recovery, and elevated mortality rates. The ERAS protocol is a comprehensive, team-based care pathway that focuses on refining perioperative management, lowering the risk of complications, and promoting faster recovery. This study investigates the effects of implementing ERAS on hospitalization duration, clinical outcomes, and perioperative complications in frail individuals undergoing short-segment lumbar fusion. Methods: We included frail patients ≥65 years who underwent one- or two-level posterior lumbar fusion for degenerative spinal disease from January 2018 to October 2020 (non-ERAS cohort) and from October 2020 to June 2023 (ERAS cohort). Demographic information, comorbidities, and surgical details were collected. The primary outcome was to compare the hospitalization duration. Additionally, other clinical outcomes, such as postoperative recovery parameters, pain scores, complications, and the Oswestry Disability Index (ODI), were recorded. Results: The study enrolled 114 frail patients, equally distributed into ERAS and non-ERAS cohorts. ERAS intervention significantly reduced the length of hospital stay (6.95 ± 2.74 days vs. 8.72 ± 4.54 days, p = 0.024) and blood transfusion rates (19.3% vs. 49.1%, p = 0.001). Time to remove the drain and indwelling catheter showed no statistically significant difference. Postoperative VAS scores and Oswestry Disability Index (ODI) scores at 6-week, 6-month, and 12-month follow-up intervals were comparable between groups. There was no significant difference in the incidence of major or minor complications between the two groups. Conclusions: Our study suggests that applying an ERAS pathway to frail individuals undergoing short-segment lumbar fusion can shorten hospital stay and lower transfusion rates, while not increasing complications, reoperations, or readmissions.

Study Design: A double-blind randomized placebo-controlled trial.Purpose: To evaluate the efficacy and safety of gabapentin (GBA) and pregabalin (PGB) versus placebo in managing neurogenic intermittent claudication (NIC), functional outcomes, and quality of life in patients with lumbar spinal stenosis (LSS). Overview of Literature: GBA and PGB are frequently prescribed for NIC associated with LSS. However, evidence supporting their efficacy, either in comparison with placebo or in direct comparison between the two gabapentinoids in LSS, remains limited.Methods: LSS patients with predominant NIC symptoms for ≥3 months were randomized (1:1:1) to receive GBA (1,800 mg/day), PGB (300 mg/day), or placebo in addition to standard conservative management, including physical therapy and naproxen. GBA and PGB were both titrated to the effective dose over 14 days. The primary outcome was NIC pain measured by Visual Analog Scale (VAS). Secondary outcomes included the Swiss Spinal Stenosis Score (SSS), self-paced shuttle walk test (SPSWT; time to NIC symptoms and walking distance), Euro-QoL Group’s 5-Dimension, 5-Level (EQ-5D-5L), and adverse effects. All outcomes were assessed monthly over 4 months.Results: Ninety patients (mean age, 63.14 years; symptoms duration, 19.38 months) were included. All groups demonstrated significant improvements in VAS, SSS, SPSWT, and EQ-5D-5L at 4 months. At 1 and 2 months, PGB showed greater EQ-5D-5L improvement compared to GBA (mean differences: 0.07 [p=0.045] and 0.08 [p=0.001], respectively). No significant differences in other outcomes were observed between groups at any time point. Adverse effects, including dizziness and sedation, were more common in the GBA and PGB groups compared to placebo (p<0.001).Conclusions: GBA and PGB did not demonstrate superior efficacy over placebo in reducing NIC and improving functional outcomes in LSS. Moreover, their use was associated with a higher incidence of adverse effects. These findings suggest limited utility for gabapentinoids as adjunctive treatments for LSS.

Study Design: Retrospective cohort study with propensity-score-matched analysis.Purpose: To compare the efficacy of vertebroplasty (VP) versus short-segment posterior instrumentation (SS) with VP in patients with osteoporotic vertebral fractures (OVFs).Overview of Literature: OVFs significantly affect the aging population, causing pain, reduced mobility, and increased dependence. Treatment guidelines vary, and a consensus on the most effective approach remains unclear. To the best of our knowledge, no previous report focused on the efficacy comparison of VP alone versus SS with VP.Methods: The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics.Results: This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups.Conclusions: SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

Purpose: To translate and culturally adapt the Core Outcome Measures Index for the back (COMI-back) into Thai and to evaluate its psychometric properties in Thai-speaking patients with low back pain (LBP). Methods: The translation process followed a standardized forward–backward method with two independent translators, followed by synthesis and back-translation. An expert committee reviewed the translations for cultural and conceptual equivalence. Pre-testing was done with Thai patients to refine the questionnaire. The validation study included 131 patients with LBP, who completed the Thai COMI-Back along with other validated questionnaires like the Oswestry Disability Index (ODI), and EQ-5D-5L. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC). Construct validity was determined by correlating COMI scores with those of reference scales. Results: The Thai COMI-Back exhibited strong reliability, with Cronbach’s alpha values from 0.89 to 0.93 and ICC values over 0.80 for all domains. Construct validity was supported by significant correlations with reference scales, with Spearman's rho values ranging from 0.47 to 0.84. Floor and ceiling effects were acceptable for most items, with notable exceptions for symptom-specific well-being and work disability. Conclusion: The Thai COMI-Back shows strong psychometric properties, making it suitable for clinical and research use in Thailand.

This study presents a systematic literature review and meta-analysis of pseudarthrosis risk factors following lumbar fusion procedures. The odds ratio (OR) and 95% confidence interval (95% CI) were used for outcome measurements. The objective of this study was to identify the independent risk factors for pseudarthrosis after lumbar spinal fusion, which is crucial for mitigating morbidity and reoperation. Systematic searches in PubMed, Embase, and Scopus (1990–July 2021) were conducted using specific terms. The inclusion criteria included prospective and retrospective cohorts and case‒control series reporting ORs with 95% CIs from multivariate analysis. The quality assessment utilized the Newcastle–Ottawa scale. Meta-analysis, employing OR and 95% CI, assessed pseudarthrosis risk factors in lumbar fusion surgery, depicted in a forest plot. Of the 568 abstracts identified, 12 met the inclusion criteria (9 retrospective, 2006–2021). The 17 risk factors were categorized into clinical, radiographic, surgical, and bone turnover marker factors. The meta-analysis highlighted two significant clinical risk factors: age (95% CI 1.02–1.11; p = 0.005) and smoking (95% CI 1.68–5.44; p = 0.0002). The sole significant surgical risk factor was the number of fused levels (pooled OR 1.35; 95% CI 1.17–1.55; p < 0.0001). This study identified 17 risk factors for pseudarthrosis after lumbar fusion surgery, emphasizing age, smoking status, and the number of fusion levels. Prospective studies are warranted to explore additional risk factors and assess the impact of surgery and graft type.

Objective : To study the factors relating to operative treatment for spinal metastasis in Thailand during 2005–2014 and to determine the hospital costs, mortality rate, and incidence of perioperative complication.Methods : Inpatient reimbursement data from 2005 to 2014 was reviewed from three national healthcare organizations, including the National Health Security Office, the Social Security Office, and the Comptroller General’s Department. The search criteria were secondary malignant neoplasm of bone and bone marrow patients (International Classification of Diseases 10th revision, Thai modification codes [ICD 10-TM], C79.5 and C79.8) who underwent spinal surgical treatment (ICD 9th revision, clinical modification procedure with extension codes [ICD 9-CM], 03.0, 03.4, 03.09, and 81.0) during 2005–2014. Epidemiology, comorbidity, and perioperative complication were analyzed.Results : During the study period, the number of spinal metastasis patients who underwent operative treatment was significantly increased from 0.30 to 0.59 per 100000 (p<0.001). More males (56.14%) underwent surgical treatment for spinal metastasis than females. The most common age group was 45–64 (55.1%). The most common primary tumor sites were the unknown origin, lung, breast, prostate, and hepatocellular/bile duct. Interestingly, the proportion of hepatocellular/bile duct, breast, and lung cancer was significantly increased (p<0.001). The number of patients who had comorbidity or in-hospital complication significantly increased over time (p<0.01); however, the in-hospital mortality rate decreased.Conclusion : During the last decade, operative treatment for spinal metastasis increased in Thailand. The overall in-hospital complication rate increased; however, the in-hospital mortality rate decreased.