For compression fracture, vertebral body height loss (VBHL) and kyphotic angle (KA) are two important imaging parameters for determining the prognosis and appropriate treatment. This study used previous measurement methods to assess the degree of VBHL and KA, compare and examine differences between various measurement methods, and examine the correlation between relevant measurement parameters and intravertebral cleft (IVC) in the vertebral body. The radiographic images (lateral view of the T-L spine) of 18 patients with a single-level vertebral compression fracture were reviewed. We measured 9 characteristic lengths and angles on plain radiographs, including anterior vertebral height (AVH) and AVH of the adjacent upper and lower levels, middle vertebral height (MVH) and MVH of the adjacent upper and lower levels, posterior vertebral height (PVH), and vertebral body width, and assessed 6 parameters, including vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), percentage of middle height compression (PMHC), kyphotic angle (KA), calculated kyphotic angle (CKA), and IVC. The results showed that VBCR is a simple and rapid method of VBHL assessment, but it may result in an underestimation of the degree of VBHL compared to PAHC. WhenPMHC<40%orkyphoticangle>15°, the probability of IVC occurring on the vertebral body was higher which means the higher risk of vertebral body instability. The results of this study could provide a reference for surgeons when using imaging modalities to assess the degree of vertebral body collapse.

Background: Liposomal bupivacaine (LB) is a relatively new formulation that slowly releases bupivacaine to extend its efficacy for 72–96 h. It is inconclusive whether LB offers better efficacy than traditional periarticular injection (TPAI) following total knee arthroplasty (TKA). Methods: Relevant randomized controlled trials (RCTs) were searched using electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. Review Manager 5.4.1 was used for calculations. Results: Sixteen RCTs were included in this meta-analysis. LB had better effects on morphine consumption equivalents during postoperative 24–48 h than TPAI. No significant difference was observed in pain relief, incidence of nausea and vomiting, or length of hospital stay between the two groups. Conclusion: LB administration during TKA is not superior to TPAI. Studies with larger sample size are needed to validate our findings. PROSPERO registration number: CRD42022355094.

Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.

Deployment or distribution of valuable medical resources has emerged as an increasing challenge to hospital administrators and health policy makers. The hospital emergency department (HED) census and workload can be highly variable. Improvement of emergency services is an important stage in the development of the healthcare system and research on the optimal deployment of medical resources appears to be an important issue for HED long-term management. HED performance, in terms of patient flow and available resources, can be studied using the queue-based approach. The kernel point of this research is to approach the optimal cost on logistics using queuing theory. To model the proposed approach for a qualitative profile, a generic HED system is mapped into the M/M/R/N queue-based model, which assumes an R-server queuing system with Poisson arrivals, exponentially distributed service times and a system capacity of N. A comprehensive quantitative mathematical analysis on the cost pattern was done, while relevant simulations were also conducted to validate the proposed optimization model. The design illustration is presented in this paper to demonstrate the application scenario in a HED platform. Hence, the proposed approach provides a feasibly cost-oriented decision support framework to adapt a HED management requirement.

Ching-Min Kuo, Wei-Jen Liao, Chun-Che Huang, Tsuo-Hung Lan, Ching-Heng Lin, Shun-Ping Wang, Cheng-Hung Lee, Ping-Wing Lui. Clin Psychopharmacol Neurosci 2020;18:562-70. https://doi.org/10.9758/cpn.2020.18.4.562

We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a medical center in Taiwan. The survival status of the study sample was confirmed by the end of March 2021. Cox-proportional hazard models were conducted to examine the effects of being overweight/obese (≥25 kg/m² vs. <25 kg/m²) and BMI (as a continuous variable) on all-cause mortality after adjusting for age, sex, history of smoking, diabetes, hypertension, chronic kidney disease, and osteoporosis. A total of 164 patients were analyzed (mean age 75.8 ± 9.3 years, male 25.6%, mean BMI 24.0 ± 4.1 kg/m²) after a median follow-up of 785 days. Compared with a BMI < 25 kg/m², a BMI ≥ 25 kg/m² was associated with a significantly lower risk of all-cause mortality (HR 0.297, 95% CI 0.101 to 0.878, p = 0.028). These findings were consistent when BMI was examined as a continuous variable (HR 0.874, 95% CI 0.773 to 0.988, p = 0.031). A low BMI (<22 kg/m²) should be considered as a risk factor for postoperative long-term mortality in this ageing population.