William Yeo - Academia.edu (original) (raw)

Papers by William Yeo

Osteoarthritis and Cartilage, 2019

Objectives: Pain sensitization could be a risk factor for poor outcomes after knee replacement su... more Objectives: Pain sensitization could be a risk factor for poor outcomes after knee replacement surgery (KR) for knee osteoarthritis (KOA). We aimed to evaluate the association between pre-operative central and peripheral pain sensitization measured using a digital pressure algometer and KR outcomes. Methods: Consecutive patients with severe KOA listed for KR were recruited. Sociodemographic and symptoms data were collected prior to surgery. Pre-operative pressure pain thresholds (PPTs) were measured using a digital pressure algometer at the index knee and forearm. Patient satisfaction at 6 and 12 months after KR was assessed using a 4-point Likert scale, and dichotomized to satisfied and dissatisfied to KR. Western Ontario and McMaster Universities Index (WOMAC) Pain and function was assessed. The associations between pre-operative PPTs with KR outcomes at 6 and 12 months were evaluated. Results: Of the 243 patients recruited, response rate at 6 and 12 months were 95.5% and 96.7%. The dissatisfaction rates were 8.2% and 5.1% at 6 and 12 months. There was no statistically significant association between pre-operative index knee or forearm PPTs and patient satisfaction. PPTs measured at the knee, but not the forearm, were weakly associated with change in the WOMAC pain score at 12 months, after adjustment for confounding factors. Conclusion: Pre-operative central sensitization, measured by handheld digital algometry, was not statistically significantly associated with satisfaction or change in pain after KR. Pre-operative peripheral sensitization was associated with change in pain symptoms after KR; however, this association was weak and unlikely to be a meaningful predictor of KR outcome in clinical practice.

Archives of Orthopaedic and Trauma Surgery, 2012

Objective To assess health-related quality of life (HRQOL) in a prospective study with 7 years of... more Objective To assess health-related quality of life (HRQOL) in a prospective study with 7 years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis. Methods Generic HRQOL was assessed with the shortform 36 (SF-36) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results Out of the 39 subjects who have completed the 7 years of follow-up of this study, 22 (56.4 %) underwent a hip replacement surgery and the other 17 (43.6 %) a knee replacement. Six months after surgery, a significant improvement, compared to preoperative scores, was observed in two of the eight dimensions of the SF-36 (i.e. physical function and pain). The same dimensions, pain and physical function, at the same time, 6 months after surgery, measured by the WOMAC, showed a significant improvement as well, but there was no significant change in the stiffness score. From 6 months to the end of followup, changes in SF-36 scores showed a significant improvement in physical function (p = 0.008), role-physical (p = 0.004) and role-emotional (p = 0.01) while all scores of the WOMAC improved (p \ 0.001 for pain, p \ 0.001 for stiffness and p \ 0.01 for physical function). Conclusion The improvements observed in HRQOL at short term after surgery, are at least maintained over a 7-year follow-up period.

$Research paper thumbnail of Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review$

Osteoporosis International, 2019

Introduction To identify, organize, and assess the evidence level of pre-discharge prognostic fac... more Introduction To identify, organize, and assess the evidence level of pre-discharge prognostic factors of physical function beyond discharge after hip fracture surgery. Methods We performed a systematic search of four databases (PubMed, Embase, CINAHL, PsycINFO) for longitudinal studies of prognostic factors of physical function at ≥ 1 month among older adults ≥ 50 years old with surgically treated hip fracture, complemented with hand-searching. Two reviewers independently screened papers for inclusion and assessed the quality of all the included papers using the Quality in Prognosis Studies (QUIPS) tool. We assigned the evidence level for each prognostic factor based on consistency in findings and study quality. Results From 98 papers that met our inclusion criteria, we identified 107 pre-discharge prognostic factors and organized them into the following seven categories: demographic, physical, cognitive, psychosocial, socioeconomic, injury-related, and process of care. Potentially modifiable factors with strong or moderate evidence of an association included total length of stay, physical function at discharge, and grip strength. Factors with strong or moderate evidence of no association included gender, fracture type, and time to surgery. Factors with limited, conflicting, or inconclusive evidence included body-mass index, psychological resilience, depression, and anxiety. Conclusions Our findings highlight potentially modifiable prognostic factors that could be targeted and non-modifiable prognostic factors that could be used to identify patients who may benefit from more intensive intervention or to advise patients on their expectations on recovery. Examining the efficacies of existing interventions targeting these prognostic factors would inform future studies and whether any of such interventions could be incorporated into clinical practice.

Spine, 2022

STUDY DESIGN Retrospective longitudinal study. OBJECTIVE To identify the preoperative factors ass... more STUDY DESIGN Retrospective longitudinal study. OBJECTIVE To identify the preoperative factors associated with postoperative lumbar fusion recovery in back or leg pain, self-reported walking time and gait speed over a 6-month period. SUMMARY OF BACKGROUND DATA The demand for lumbar fusion surgeries has significantly increased over the years. Yet, some patients report persistent postsurgical pain and poor functional outcomes. Unfortunately, the associated risk factors are not well understood. METHODS The study analysed 232 subjects with mono- or bi-segmental lumbar fusion surgery who underwent standardized assessment preoperatively and at 4, 12, and 24 weeks postoperatively. Preoperative variables collected were demographic, clinical and psychological variables. Back or leg pain was measured by the Numeric Pain Rating Scale. Walking disability was measured by self-reported walking time and performance-based fast gait speed. Risk factors of pain and walking disability over time were identified using ordinal and linear mixed-effects modelling. RESULTS At 6months post-surgery, 17% of patients reported having moderate or severe back/leg pain and 24% were unable to walk longer than 30 minutes. Greater preoperative self-reported leg weakness frequency and body-mass-index (BMI) were strongly associated with greater pain and walking disability. Additionally, greater preoperative depression symptoms were associated with greater back/leg pain (aOR = 4.0) and shorter walking time (aOR = 2.7) - but not with slower gait speed (difference = 0.01m/s). Old age and female gender were strongly associated with gait speed but not with self-reported walking time. CONCLUSION A sizable proportion of patients had poor pain and walking outcomes even at 6 months post-surgery. Preoperative leg weakness and BMI were consistent risk factors and patients with greater depression symptoms may have poorer self-reported outcomes. Although requiring validation, our study has identified potentially modifiable risk factors which may give clinicians an opportunity to provide early (preoperative) and targeted intervention strategies to optimise postoperative outcomes.

Annals of Clinical and Laboratory Research, 2018

Introduction: To determine the effect of bipolar sealant on transfusion rates in primary total hi... more Introduction: To determine the effect of bipolar sealant on transfusion rates in primary total hip arthroplasty (THA) using the direct anterior approach (DAA). Methods: Fifty-nine patients in total were recruited for the study. The first group (n:37) underwent THA DAA using the conventional bipolar diathermy and the second (n:22) group underwent THA DAA with the aid of aquamantys bipolar sealant. Mean difference in postoperative drop in haemoglobin levels were charted and transfusion rates were compared. The statistical analysis was performed using SPSS 2.0 software for windows. Results: The use of bipolar sealants did not significantly reduce hemoglobin drop (p>0.05). It did, however, significantly reduce the rate of transfusion (p=0.013) Conclusion: Our study suggests that the use of bipolar sealants were superior to conventional bipolar cautery in patients undergoing primary THA using the DAA, causing a significant drop in the need for post-operative packed cell transfusions. Hence, the use of bipolar sealant is recommended in primary THA using the DAA.

Study Design: Retrospective review of prospectively collected data. Objective: To determine the r... more Study Design: Retrospective review of prospectively collected data. Objective: To determine the relationship between cervical sagittal balance and adjacent segment degeneration (ASD) development after 3-level anterior cervical discectomy and fusion (ACDF). Summary of Background Data: ASD is a common complication after ACDF. Previous studies have shown that sagittal imbalance may be associated with ASD development after 1-level or 2-level ACDF. However, these findings may not be generalizable to 3-level procedures. Materials and Methods: We reviewed prospectively collected data of 46 patients who underwent 3-level ACDF at a tertiary institution. Lateral cervical radiographs taken preoperatively, postoperatively, and at last follow-up were reviewed for ASD. The mean follow-up duration was 5 years. Radiographic parameters measured were cervical sagittal alignment (CSA), segmental sagittal alignment, T1 slope (T1S), sagittal vertical axis, and T1S−cervical lordosis. Results: ASD was pre...

Journal of Hospital Infection, 2019

BACKGROUND The role of laminar flow (LAF) is contradictory with several studies failing to replic... more BACKGROUND The role of laminar flow (LAF) is contradictory with several studies failing to replicate risk reduction. The 2016 World Health Organization guidelines identified this lack of good comparative studies. AIM To analyse the use of LAF and the incidence of prosthetic joint infections (PJIs) in Asian patients undergoing total knee replacement (TKR). METHODS Patients who underwent standard cemented posterior-stabilized TKR from 2004 to 2014 were reviewed from a prospectively collected single-surgeon database. Revision, traumatic and/or inflammatory cases were excluded. The type of airflow used was identified. The technique and surgical protocol for all procedures were similar. Tourniquets and inserted drains were routinely used. Patellar resurfacing was not performed. Patients were followed up at the outpatient clinics at regular intervals up to two years. At each visit, the patient was assessed for the occurrence of PJI. FINDINGS Of the 1028 procedures, 453 (44.1%) were performed in an LAF operating theatre (OT) whereas 575 (55.9%) were performed in a non-LAF OT. There were no significant differences between the two groups in terms of age, gender, or side of procedure. The overall incidence of PJI was 0.6% (N = 6). Three (50%) occurred in an LAF OT whereas three (50%) occurred in a non-LAF OT. This was not statistically significant. CONCLUSION Laminar flow systems are costly to procure and maintain. With modern aseptic techniques, patient optimization, and use of prophylactic antibiotics, laminar flow does not appear to further reduce risk of PJI in Asian patients after TKR.

Asian Spine Journal, 2016

Comparison of prospectively collected data of patients undergoing minimally invasive surgery tran... more Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). Purpose: To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. Overview of Literature: BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up. Methods: From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted. Results: The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively. Conclusions: The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up.

Spine, 2009

Prospective study. Comparison of clinical and radiologic outcomes of minimally invasive (MIS) ver... more Prospective study. Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF). Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery. From 2004-2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years. The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and Quality of Life scores (Short Form-36, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.

Spine, 2013

organic erectile dysfunction, it is not surprising that this topic has been of great interest. Ex... more organic erectile dysfunction, it is not surprising that this topic has been of great interest. Excellent long-term survival rates may also play a role in making quality of life a topic of principal interest when managing prostate cancer. Despite the primacy of prostate cancer in the literature on postcancer erectile dysfunction, colorectal surgery carries similar risks of erectile dysfunction in men and may also exert a substantial toll on the sexual lives of women. This study highlights that well-established association and sheds some light on the relatively greater burden on patients with recurrent or advanced disease. It is limited by absence of data on preoperative sexual function and by the cross-sectional nature. Additional prospective studies (and, more importantly, treatment trials) are warranted to optimize sexual function outcomes in colorectal cancer survivors.

Physiotherapy, 2014

To explore the use of the Risk Assessment and Predictor Tool (RAPT) as a pre-operative tool to pr... more To explore the use of the Risk Assessment and Predictor Tool (RAPT) as a pre-operative tool to predict postoperative discharge destination and length of stay for patients undergoing total knee replacement (TKR) in Singapore. A cohort of 569 patients undergoing primary TKR at the Singapore General Hospital were recruited prospectively from November 2009 to June 2010. All patients completed a modified RAPT questionnaire pre-operatively, and underwent standard clinical pathway guidelines for TKR throughout the study. Actual discharge destination (ADDest) and length of stay (LOS). Total RAPT score and preferred discharge destination (PDD) were recorded pre-operatively, while ADDest and LOS were obtained immediately after discharge. Multivariable logistic regression and multivariable regression analysis were used to determine whether the RAPT items and score could predict the discharge outcomes. Total RAPT score was a significant predictor of LOS for patients following TKR (R=0.24, P&amp;lt;0.001); the higher the RAPT score, the longer the LOS. Total RAPT score was also a significant predictor of actual discharge to home [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.11 to 4.85]. PDD was a significant predictor for LOS (R=0.22, P&amp;lt;0.001) and ADDest (R=0.33, P&amp;lt;0.001). Patients who chose to be discharged home were more likely to be directly discharged home (OR 9.79, 95% CI 5.07 to 18.89, P&amp;lt;0.001). Total RAPT score and PDD were significant predictors of ADDest and LOS for patients following TKR in Singapore. The ability to predict discharge outcomes following TKR could assist caregivers, healthcare professionals and administrators in optimising care and resource allocations for patients.

Osteoarthritis and Cartilage, 2006

Objective: To cross-culturally adapt and validate Singapore English and Chinese versions of the K... more Objective: To cross-culturally adapt and validate Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with knee osteoarthritis (OA) in Singapore. Methods: Singapore English and Chinese versions were cross-culturally adapted from the source English KOOS following standard guidelines (including cognitive debriefing). Patients were asked to complete identical questionnaires containing the KOOS, Short Form 36 Health Survey, and EQ-5D twice within 6 days. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and convergent and divergent construct validity using 14 and 13 a priori hypotheses, respectively. Results: Singapore English and Chinese KOOS versions were well accepted by patients in pilot testing and were therefore administered to a consecutive sample of 127 English and 131 Chinese-speaking Singaporeans with knee OA. Cronbach's alpha exceeded 0.7 for all domains except for Chinese pain and symptoms domains. ICC exceeded 0.7 for all domains except for English sport and recreation and Chinese kneerelated QoL domains. Hypothesized item-to-domain correlations (Spearman's r ! 0.4) were observed for 38 items in English and 29 in Chinese versions. Convergent construct validity was supported by the presence of hypothesized moderate/strong correlations (r ¼ 0.37e0.65) for 13 and 11 a priori hypotheses in the English and Chinese KOOS, respectively. Divergent construct validity was supported by the presence of weak correlations (r ¼ 0.02e0.34) for 12 and 11 a priori hypotheses in the English and Chinese KOOS, respectively. Conclusion: The Singapore English and Chinese KOOS were well accepted and demonstrated acceptable reliability and validity in Asian patients with knee OA in Singapore.

Journal of Orthopaedic Surgery and Research, 2009

Background: Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few stu... more Background: Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to work. Method: 55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 scores (SF-36) and Pain Visual Analogue Scale (VAS) and return to work. Results: The mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p < 0.05) at 6 months and 2 years. There was significant improvement in all aspects of the Quality of Life (SF-36, p < 0.05) scores except for general health at 6 months and 2 years postoperation. The recurrence rate was 5% (3 patients). 5% (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24.3 days. Conclusion: Percutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.

Journal of Spinal Disorders and Techniques, 2015

We conducted a retrospective analysis of a prospectively collected database in a tertiary hospita... more We conducted a retrospective analysis of a prospectively collected database in a tertiary hospital over 10 years. Treatment for vertebral compression fractures remains an area of controversy with respect to timing and type of surgical management. We analysed the clinical outcomes and radiographic measurements of four different modalities of treatment for these fractures. From 2001 to 2011, we analysed a total of 363 patients after failure of 30 days of conservative management. These patients where then further managed either conservatively or with Vertebroplasty (VP), Balloon Kyphoplasty (BK) or Sky Bone Expander (SK). Outcomes were assessed by using Self-Report Measures: Visual Analog Score (VAS), Functional measures, Oswestry Disability Index (ODI) and Short-Form 36 (SF-36); and Physiologic Measures: Pre and Post-operative Radiographs. The outcome measures were assessed for six months for those treated conservatively and up till two years for those treated surgically. Radiographic measurements of the spine were correlated with the clinical outcomes. A total of 62 patients (12.1%) were treated conservatively, 148 (40.8%) with VP, 97 (26.7%) with BK and 56 (15.4%) with SK. We found significant improvements in VAS, ODI and SF-36 scores for all groups after one month follow-up (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), with the surgical groups demonstrating a greater improvement in pain scores after the 1st post-operative day (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) when compared to the conservative group. The improvements in outcomes in those treated surgically were sustained for up to two years with no significant difference (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05) amongst the surgical groups. We also found significant improvement (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005) in anterior vertebral and kyphotic wedge angle after surgical intervention. We have shown that early surgical intervention allows for quicker pain relief compared to conservative treatment, with similar improvements in anterior vertebral height and kyphotic wedge angle between all 3 groups of surgical management.

Journal of Orthopaedic Surgery

Introduction: Reduction in neuroforaminal height (FH) may diminish the indirect decompression ben... more Introduction: Reduction in neuroforaminal height (FH) may diminish the indirect decompression benefit that lateral access surgery (LAS) provides. However, the relationship between postoperative FH reduction in LAS and health-related quality-of-life (HRQoL) outcomes remains unclear. Objectives: To determine whether FH reduction affects HRQoL outcomes at 2-year follow-up. Methods: A retrospective review of 45 patients who underwent LAS for degenerative lumbar spine conditions was performed. The cohort was divided into two groups: maintenance (A) and reduction (B) in FH. Outcome measures included numerical pain rating scale (NPRS back and leg pain), Oswestry Disability Index (ODI), Short Form 36 Health Survey (SF-36), North American Spine Society (NASS) score for neurogenic symptoms (NS), patient satisfaction, and expectation fulfilment for surgery. Mean disc height (DH), FH, and fusion were evaluated on plain radiographs. Radiological fusion was assessed with the Bridwell fusion classification. Unpaired student's t-test was used to compare between groups and one-way ANOVA with Bonferroni post hoc correction was used to determine differences between time intervals within each group. Results: The average pre-op mean FH was 16.9 + 3.5 mm. Group A had 25 patients showing postoperative maintenance of FH (19.4 + 3.3 mm to 20.2 + 3.2 mm; 4% increase) at 2-year postsurgery while group B had 20 patients showing decrease in FH (21.1 + 3.3 mm to 18.7 + 3.5 mm; 11% decrease). Group A mean DH improved from 7.0 + 2.0 mm to 10.3 + 1.6 mm (47% increase). Group B mean DH improved from 6.8 + 2.3 mm to 11.0 + 3.0 mm (62% increase). There were no significant differences in NPRS, ODI, NASS, SF-36, and SF-36 MCS/PCS between groups at 2 years (p > 0.05); 92% of group A and 85% of group B patients reported good satisfaction and fulfilment of expectations (p > 0.05). Conclusion: Despite an initial increase in FH after LAS surgery, 45% of patients had FH reduction at 2 years. However, FH reduction up to 11% did not affect short-term HRQoL outcomes.

SPINE

Study Design. Retrospective study using prospectively collected registry data. Objectives. To eva... more Study Design. Retrospective study using prospectively collected registry data. Objectives. To evaluate the effect of obesity on patient-reported outcome measures of pain, disability, quality of life, satisfaction, and return to work after single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Summary of Background Data. MIS-TLIF is an appealing alternative for obese patients with potentially lower complication risk. However, there is limited data investigating the influence of obesity on outcomes 5 years after MIS-TLIF. Methods. Prospectively collected registry data of 296 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had complete 2- and 5-year follow-up data. Patients were stratified into control (<25.0 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2) groups. Outcomes assessed were visual analogue scale for back pain, leg pain, Oswestry Disability Index, Short-form 36, North American Spine Society score for neurogenic symptoms, return to work (RTW), return to function (RTF), satisfaction, and expectation fulfilment. Length of operation, length of stay, and comorbidities were recorded. Results. Among the patients, 156 (52.7%) had normal weight, 108 (36.5%) were overweight, and 32 (10.8%) were obese. There was no difference in length of operation or hospitalization (P > 0.05). All three groups had comparable preoperative scores at baseline (P > 0.05). At 5 years, the control group had significantly higher PCS compared with the overweight (P = 0.043) and obese groups (P = 0.007), although the change in scores was similar (P > 0.05). The rate of MCID attainment, RTW, RTF, expectation fulfilment, and satisfaction was comparable. Conclusion. Nonobese patients had better physical well-being in the mid-term, although obese patients experienced a comparable improvement in clinical scores. Obesity had no impact on patients’ ability to RTW or RTF. Equivalent proportions of patients were satisfied and had their expectations fulfilled up to 5 years after MIS-TLIF. Level of Evidence: 3

Journal of Orthopaedic Surgery, 2016

Purpose To identify predictors for rehabilitation outcome in Asian geriatric hip fracture patient... more Purpose To identify predictors for rehabilitation outcome in Asian geriatric hip fracture patients. Methods Records of 153 consecutive Asian patients aged 61 to 99 years who underwent surgery for hip fracture and were followed up for at least one year were reviewed. They were stratified into 4 age-groups: 60–69 years (n=27), 70–79 years (n=70), 80–89 years (n=50), and ≥90 years (n=6). Any comorbidity, regardless of severity, was recorded. Pre-injury and postoperative functional status was evaluated using the 36-item Short Form Health Survey. Relative functional gain (RFG) is equal to absolute functional gain (physical component summary [PCS] score at one year minus PCS score at 6 weeks) divided by the maximum potential gain (maximum PCS score minus PCS score at 6 weeks). RFG of <0.5 and ≥0.5 is defined as poor and good rehabilitation outcome, respectively. Results In univariate analysis, age 80–89 years (p=0.026), arthritis (p=0.082), and hypercholesterolaemia (p=0.014) were pred...

International Journal of Spine Surgery

Background: Lateral access surgery (LAS) for lumbar degenerative spondylolisthesis is a minimally... more Background: Lateral access surgery (LAS) for lumbar degenerative spondylolisthesis is a minimally invasive lumbar fusion technique which has been gaining increasing popularity in the recent years. This study aims to identify perioperative factors that influence postoperative satisfaction after LAS for lumbar degenerative spondylolisthesis. Methods: From August 2010 to November 2014, 52 patients with lumbar degenerative conditions (16 male: 36 female, mean age 64.0 6 8.7 years) were prospectively recruited and underwent LAS by a single surgeon. All patients were assessed preoperatively and 2 years postoperatively with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, Short-Form 36 (SF-36) scores, North American Spine Society score for neurogenic symptoms, patient satisfaction, and expectation fulfillment. Cobb angles, global lumbar lordosis, disc heights, adjacent disc heights, fusion, and subsidence were rates assessed. Multiple linear regression performed with satisfaction as dependent variable to identify predictive independent variables. Results: Lower preoperative SF-36 general health scores (P ¼ .03), higher NPRS leg pain scores (P ¼ .04), and longer surgical duration (P ¼ .02) were significant predictors of lower satisfaction (P , .05). NPRS back and leg pain decreased by 80.3 and 83.0%, respectively. Oswestry Disability Index and North American Spine Society score for neurogenic symptoms improved by 76.2 and 75.9%, respectively. Ninety percent of patients reported excellent/good satisfaction. Significant correction and maintenance of Cobb and global lumbar lordosis angles were achieved. There was significant increase in disc heights postoperatively (P ¼ .05) and no significant difference in adjacent disc heights at 2 years (P. .05). Ninety-eight percent of patients achieved Bridwell Fusion Grade 1, and 5.8% had Marchi Grade 3 subsidence. Conclusions: Lower preoperative SF-36 general health, higher NPRS leg pain, and longer surgical duration are predictors of lower satisfaction in patients undergoing LAS for lumbar degenerative spondylolisthesis. Level of Evidence: III. Clinical Relevance: Identifying preoperative predictors for postoperative clinical outcome can assist clinicians in patient education prior to operation.