Put together outcomes of continual PM2A few direct exposure as well as habitual physical exercise upon cancers mortality a new longitudinal cohort study

There is a significant need for research and understanding of underactive bladder (UAB). The International Congress of Urologic Research and Education on Aging UnderActive Bladder (CURE-UAB) was organized by Doctors Michael Chancellor and Ananias Diokno in order to address these concerns. CURE-UAB was supported, in part, by the US National Institute of Aging and National Institute of Diabetes Digestive and Kidney. Since 2014, there have been 5 successful CURE-UAB congresses. They have brought together diverse stakeholders in the UAB field to identify areas of major scientific challenge and initiated a call to action among the medical community. In this review, we will highlight current and novel treatments under development for UAB and the progress and impact from the CURE-UAB initiative.OBJECTIVE The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. METHODS A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008-2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use. RESULTS A total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p less then 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age less then 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p less then 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. CONCLUSION Patients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.OBJECTIVE The concept of enhanced recovery after surgery (ERAS) is relatively new to the neurosurgical field. The introduction of an ERAS protocol in lumbar fusion surgery has aimed to accelerate patient recovery from surgery by reducing in-hospital opioid consumption. METHODS Patients with 1- or 2-level degenerative lumbar spine disease and who underwent ERAS transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. Patients' general demographic data, in-hospital opioid dosage (converted to morphine equivalents), and hospital stay were compared to those who underwent standard minimally-invasive (MIS)-TLIF. RESULTS Twenty-four patients who received ERAS TLIF (the ERAS group) were compared to a series of 24 patients who received standard MIS-TLIF (the MIS group). The demographic data were similar. The operation time and blood loss significantly favored ERAS TLIF. The average daily opioid consumption was remarkably lower in the ERAS group than the MIS group. Average opioid dosage throughout the entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group. The average length of hospital stay was substantially shorter in the ERAS group (1.4 ± 1.13 days vs. 4.0±1.98 days, p less then 0.001). CONCLUSION The present study demonstrated a significant decline in the consumption of opioids and in the hospital length of stay for patients undergoing ERAS TLIF for 1- or 2-level degenerative lumbar spine disease.OBJECTIVE To identify possible radiographic predictors markers of dynamic instability including disc height (DH), disc degeneration, and spondylosis in the setting of degenerative spondylolisthesis (DS). METHODS A retrospective review with prospectively collected data was performed on 125 patients with L4-5 DS who underwent decompression and fusion. Patients were divided into groups with dynamic instability and those without. Radiographs of the lumbar spine in neutral, flexion, and extension were used to determine degree of slip, DH, translational motion, angular motion, spondylotic changes, and lumbar lordosis. Magnetic resonance imaging (MRI) scans were reviewed to assess disc degeneration. RESULTS Thirty-one percent of the patients met criteria for dynamic instability. Significant correlations (p less then 0.05) were found between preserved DH and dynamic instability; increased spondylotic changes and decreased translational motion; as well as advanced MRI-based disc degeneration scores with decreased angular motion, respectively. Six radiographic parameters were utilized to create a predictive model for dynamic instability, and a receiver operating characteristic curve was able to validate the predictive model (area = 0.891, standard error = 0.034, p less then 0.001). Serine inhibitor CONCLUSION In DS patients, preserved DH was significantly related to dynamic instability. This finding may represent a greater potential for slip progression over time in these patients. In contrast, disc degeneration on MRI, and spondylotic changes were inversely related to dynamic instability and may represent restabilization mechanisms that decrease the chance of future slip progression in DS.OBJECTIVE Low back pain is the most common reason for physician visit in Western population. It's one of the factors that affect health-related quality of life. Intervertebral disc degeneration is one of the leading factors for low back pain and disc degeneration needs serious attention. In this article, we try to summarize biomechanical factors on the degenerative process. METHODS Patients with low back pain in Neurosurgery Department between January 2012 and June 2019 are searched for this study. The patients were gathered under 2 groups; surgical intervention and conservative treatment groups. Intervertebral disc degeneration was assessed by Pfirrmann grading system. All spinopelvic parameters were measured by using standardized lateral plain standing lumbar radiographs. RESULTS There were 165 patients in the surgical group (60 females, 105 males) and 84 patients in the conservative group (57 females, 27 males) after randomization. One hundred fifty patients had microdiscectomy and 15 patients had spinal instrumentation with transforaminal lumbar interbody fusion. There was not a statistically significant difference between surgical intervention and conservative treatment groups when comparing disc degeneration status. There was a statistically significant difference in parameters lumbar lordosis (LL), L4-S1, and pelvic incidence-LL (PI-LL) between the 2 treatment groups. In the surgical group when we further analyze the spinopelvic parameters in between the 2 different surgical techniques; L4-S1, pelvic tilt, and PI-LL showed a statistically significant difference. CONCLUSION Degenerative disc disease is related with multiple factors which can be detailed under the mechanic components and the genetic components. Of these factors, spinopelvic parameters seem highly penetrating to patients' surgery needs with degenerative disc disease independently.OBJECTIVE While it has been established that surgery for lumbar disc herniation, excluding emergent indications, should only be performed after weeks of conservative treatment, it has also been established that late surgery is associated with poorer outscomes in terms of leg pain. However, nothing is known concerning the timinig and functional outcome. We quantify the association of time to surgery (TTS) with functional impairment outcome and identify a maximum TTS cutoff. METHODS A consecutive series of patients who underwent tubular microdiscectomy for lumbar disc herniation was included. A reduction of ≥ 30% in the Oswestry Disability Index from baseline to 12 months was defined as the minimum clinically important difference (MCID). TTS was defined as time of symptom onset to surgery in weeks. The maximum TTS cutoffs were derived both quantitatively by an area under the curve (AUC) analysis, as well as qualitatively based on cutoff-specific MCID rates. RESULTS Inclusion was met by 372 patients, among which 327 (87.9%) achieved MCID. MCID achievement was associated with lower TTS (hazard ratio, 0.725; 95% confidence interval, 0.557-0.944; p = 0.014). The optimum maximum TTS based on AUC was 21.5 weeks. The qualitative analysis showed a continuous drop of MCID rates with increasing TTS, with values > 80% until week 14. CONCLUSION Our findings suggest that longer TTS is associated with a poorer patient-reported outcome in terms of functional impairment, and that-depending on the calculation method and according to the literature-a maximum TTS of between 14 to 22 weeks should likely be aimed for.OBJECTIVE To assess the impact of Modic changes (MC) on preoperative symptoms, and postoperative outcomes in anterior cervical discectomy and fusion (ACDF) patients. METHODS We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings were used to assess the presence of MC. MC were stratified by type and location, and compared to patients without MC. Associations with symptoms, patient-reported measures, and surgical outcomes were assessed. RESULTS A total of 861 patients were included, with 356 patients with MC (41.3%). MC more frequently occurred at C5-6 (15.1%), and type II was the most common type (61.2%). MC were associated with advanced age (p less then 0.001), more levels fused (p less then 0.001), a longer duration of symptoms, but not with specific symptoms. MC at C7-T1 resulted in higher postoperative disability (p less then 0.001), but did not increase risk of adjacent segment degeneration or reoperation. CONCLUSION This study is the first to systematically examine the impact of cervical MC, stratified by type and location, on outcomes in ACDF patients. Patients with MC were generally older, required larger fusions, and had longer duration of preoperative symptoms. While MC may not affect specific outcomes following ACDF, they may indicate a more debilitating preoperative state for patients.OBJECTIVE To determine the effect of anterior plating on postoperative dysphagia (POD) among adult patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylosis and determine the potential role of demographic and clinical characteristics in the development of POD. METHODS Consecutive adults undergoing an elective, single-level, ACDF were randomly assigned to receive a stand-alone CoRoent Cage or a CoRoent Cage with a Helix, or HelixMini plate. Patients with a history of cervical spine surgery were excluded. M. D. Anderson Dysphagia Inventory and Bazaz questionnaires were completed at regular intervals for 12 months postoperatively. RESULTS Twenty-five patients were recruited over a 2-year period, with 8 allocated to receive a stand-alone cage, 5 to receive a cage and Helix Mini plate, and 12 to receive a cage and Helix plate. The POD rate was 68% at 48 hours, before falling to 16% at 6 and 12 months. A longer retraction time was observed in the Helix plate group compared to the stand-alone cage group (7.