Background and Objectives: Hyponatraemia increases the morbidity and mortality risks of orthopaedic patients. When undergoing spine surgery, hyponatraemic patients have high risks of pneumonia and of staying in hospital for up to 1 day longer compared with non-hyponatraemic patients. This study aims to assess the occurrence of adverse events among patients with pre-operative hyponatraemia after undergoing lumbar surgery. Materials and Methods: A retrospective cohort study was conducted. Patients who underwent spinal surgery in 2011 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between hyponatraemic patients and normonatraemic patients. Post-operative adverse events, need for blood transfusion and length of stay were considered as clinical outcome data. Results: A total of 58,049 patients were included; pre-operatively, 55,012 (94.8%) were normonatraemic and 3037 (5.2%) were hyponatraemic. Multivariate analysis showed that hyponatraemic patients had higher rates of adverse events, blood transfusions and urinary tract infections. Specifically, 632 (20.8%) hyponatraemic patients developed adverse events, compared with 6821 (12.4%) normonatraemic patients; the hyponatraemic patients received transfusions, compared with 6821 (7.4%) normonatraemic patients; and 97 (3.2%) hyponatraemic patients developed urinary tract infections, compared with 715 (1.3%) normonatraemic patients. Finally, an extended length of stay beyond 6 days occurred in 604 (19.9%) hyponatraemic patients, compared with 4676 (8.5%) normonatraemic patients. Conclusions: Our study identified an association between pre-operative hyponatraemia and post-operative adverse events in spinal surgery patients. However, it is unclear whether hyponatraemia caused the higher adverse event rate.

Background: Complementary and alternative medicine (CAM) treatment practices are frequently utilized by patients alongside conventional modern medicine. CAM options are commonly practiced by orthopedic trauma patients and are usually driven by cultural and sometimes religious beliefs. This study aims to evaluate the prevalence, practices and influencing factors of CAM use among orthopedic patients. Methodology: An observational cross-sectional survey study was carried out at the Orthopedic Department fracture clinics in a tertiary trauma center in Riyadh, Saudi Arabia. Participants were recruited from orthopedic fracture clinics and requested to complete a questionnaire survey. Results: Among the 356 surveyed fracture patients, 49.4% reported using CAM. Of these CAM users, 20.5% patients used CAM for the first time after being diagnosed with fracture, while 79.5% of patients had previously utilized CAM and increased their usage after fracture diagnosis. CAM practices were significantly associated with older age, joint reconstructive fracture treatment, and reported disability/dependence. Fenugreek was the most commonly consumed type by 81% of CAM users. The key motivations for CAM use were the perception of enhancing the fracture healing process and maintaining good health. Notably, 61.5% of CAM users reported experiencing improvements in their physical health, while 9.0% of the users experienced adverse effects such as weight gain and joint pain. Conclusion: Our study shed a light on the high prevalence of CAM usage among fracture patients, with Fenugreek being the most popular. Potential influencing factors for CAM practices were investigated including demographic, socioeconomic as well as fracture-related factors. Despite its high prevalence, CAM use is often not discussed with the treating physicians, therefore, increased physician awareness and enhanced patient communication about CAM practices are essential. Further investigations are required to explore CAM adverse effects as well as impact on fracture healing and general health.

Background Proximal junctional kyphosis (PJK) is a common complication of long spinal fusion. The prevalence of PJK ranges between 6 and 41% and frequently requires reoperation. One of the potential causes is thought to be posterior muscle dissection within the fused range at the time of posterior fusion. Various measurement protocols have been tested to evaluate extensor muscle strength, endurance and power in adults. However, it is not universally accessible and is rarely used clinically due to the high cost, requirement for considerable user expertise, demands on the functional capacities of the patient and protracted testing time. Currently, the Biering–Sørensen test is the most widely used isometric test for assessing extensor muscle endurance. But, it was deemed unsuitable and difficult for older patients with chronic low back pain undergoing spine surgery. In this study, we designed a simple method that allows us to perform lumbar spine extensor strength tests in a comfortable seated position. This study aimed to assess the within-day and between-day reliability of this novel test for evaluating back extensor strength in healthy individuals. Methods In this study, we examined 79 healthy subjects (33 males and 46 females), who were 25–63 years of age. The subjects were placed in a seated position on the novel chair and secured tightly with a lap belt. In each session, the subjects were asked to extend their backs against the force transducer at maximum capacity, maintaining the extension for 5 seconds. The maximal force delivered over that period was recorded. The subjects had a practice trial followed by three forceful extensions with pausing intervals of 30 seconds. Measurements were obtained by one of three trained raters, and the average force of all three trials was recorded. A follow-up session was carried out within 14 days. Intra-class correlation coefficients (ICCs) were used to assess within-day and between-day reliability. Results The mean force in the initial session was 314.6±118.3 N, and it was 318.6±123.6 N in the follow-up session. The ICCs for within-day reliability and between-day reliability were 0.89 [95%CI: 0.83–0.92] and 0.88 [95% CI: 0.81–0.93], respectively. There was a strong correlation between the average measures of the initial and follow-up sessions (r = 0.80; p < 0.001; R2 = 0.62). Conclusion The use of the static dynamometer chair is a reliable, non-invasive, cost-effective test that facilitates the assessment of the strength of lumbar spine extensors in healthy adults.