Grzegorz Miekisiak

Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index.

Study Design. Validation of a translated, culturally adapted questionnaire. Objective. To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients. Summary of Background Data. The ODI is among the most popular questionnaires used to evaluate back pain–related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated. Methods. The questionnaire was translated and culturally adapted by 2 independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland–Morris disability questionnaire, VAS for low back and leg and 3 Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled, and 84 of 164 (53%) returned the completed retest booklet within 2 to 14 days after the baseline test. There were no differences between the 2 groups in demographic and clinical parameters. Test-retest reliability, internal consistency, and construct validity were investigated. Results. The mean ODI (standard deviation [SD]) was 48.45 (18.94); minimum 2, maximum 94. The Cronbach &agr; for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the Roland–Morris disability questionnaire score was very good (r = 0.607, P < 0.001). The correlation with VAS back was fair (r = 0.37, P < 0.001) and with VAS leg was good (r = 0.56, P < 0.001). The tested ODI had excellent test-retest reliability, the intraclass correlation coefficient was 0.97 and standard error of measurements was 3.54, the resulting minimal detectable changes at the 95% confidence level was 10. Conclusion. The results of this study indicate that the Polish version of the ODI is a reliable and valid instrument for the measurement of disability in Polish-speaking patients with lower back pain.

Creation of an In-House Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Corynebacterineae Database Overcomes Difficulties in Identification of Nocardia farcinica Clinical Isolates

ABSTRACT Nocardiosis is a rare disease that is caused by Gram-positive actinobacteria of the Nocardia genus and affects predominantly immunocompromised patients. In its disseminated form, it has a predilection for the central nervous system and is associated with high mortality rates. Therefore, prompt identification of the pathogen is critical. Matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry is a relatively novel technique used for identification of microorganisms. In this work, an upgraded MALDI-TOF Biotyper database containing Corynebacterineae representatives of strains deposited in the Polish Collection of Microorganisms was created and used for identification of the strain isolated from a nocardial brain abscess, mimicking a brain tumor, in an immunocompetent patient. Testing with the API Coryne system initially incorrectly identified Rhodococcus sp., while chemotaxonomic tests, especially mycolic acid analysis, enabled correct Nocardia identification only at the genus level. Subsequent sequence analysis of 16S rRNA and secA1 genes confirmed the identification. To improve the accuracy of the results, an in-house database was constructed using optimized parameters; with the use of the database, the strain was eventually identified as Nocardia farcinica. Clinical laboratories processing various clinical strains can upgrade a commercial database to improve and to accelerate the results obtained. This is especially important in the case of Nocardia, for which valid microbial diagnosis remains challenging; reference laboratories are often required to identify and to survey these rare actinobacteria.

Increased Radiation but No Benefits in Pedicle Screw Accuracy With Navigation versus a Freehand Technique in Scoliosis Surgery

Background The clinical value of pedicle screws in spinal deformity surgery is well known; however, screw insertion is demanding and sometimes associated with complications. Navigation systems based on intraoperatively obtained three-dimensional (3-D) images were developed to minimize pedicle screw misplacements. However, there is a lack of data confirming superiority of navigation above other techniques. There are also concerns regarding increased radiation used during the procedure. Questions/purposes The purposes of this study were (1) to compare accuracy of the two methods of pedicle screws placement: intraoperative 3-D image navigation versus a freehand technique in patients with idiopathic scoliosis; and (2) to assess the radiation dose received by patients with both methods. Methods Between 2014 and 2016, 49 patients underwent posterior spinal fusion with all pedicle screw constructs for idiopathic scoliosis performed by two surgeons. The study design involved alternating the use of the freehand technique and navigation to position pedicle screws in consecutive patients, forming groups of 27 patients with 451 navigated screws and 22 patients with 384 screws positioned freehand. The two groups did not differ in age, sex, or magnitude of deformity. Two observers not involved in the treatment evaluated the position of the screws. The pedicle breach was assessed on intraoperatively obtained 3-D O-arm® scans according to a grading system: Grade 0 = no pedicle wall violation; Grade 1 = perforation ⩽ 2 mm; Grade 2 = 2 to 4 mm; and Grade 3 = perforation > 4 mm. Grades 0 and 1 were considered properly positioned and Grades 2 and 3 represented malposition. Results In terms of accuracy, we found no differences, with the numbers available, between the freehand and navigated groups in terms of the proportion of screws that were properly positioned (96% freehand and 96% in the navigation group, respectively; p = 0.518). Grade 3 pedicle screws were observed only in the freehand group and were all located in the upper thoracic spine. Patients undergoing navigated pedicle screw placement received a greater mean radiation dose than those whose screws were placed freehand (1071 ± 447 mGy-cm versus 391 ± 53 mGy-cm; mean difference, 680 mGy-cm; 95% confidence interval, 217-2053 mGy-cm; p < 0.001). Conclusions In patients with moderate idiopathic scoliosis undergoing primary surgery, we did not observe benefits of pedicle screw placement with CT-based navigation, but the patients experienced greater exposure to radiation. Level of Evidence Level III, therapeutic study.

Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

INTRODUCTION Herniated lumbar disc (HLD) is arguably the most common spinal disorder requiring surgical intervention. Although the term is fairly straightforward, the exact pathology and thus the clinical picture and natural history may vary. Therefore, it is immensely difficult to formulate universal guidelines for surgical treatment. AIM The aim of this paper is to organize the terminology and clear the inconsistencies in phraseology, review treatment options and gather available published evidence to address the clinical questions to create a set of clinical guidelines in relevant to the topic. METHODS AND RESULTS Twelve queries, addressing optimal surgical treatment of the HLD have been formulated. The results, based on the literature review are described in the present work. The final product of the analysis was a set of guidelines for the surgical treatment of symptomatic HLD. Categorized into four tiers based on the level of evidence (I-III and X), they have been designed to assist in the selection of optimal, effective treatment leading to the successful outcome. CONCLUSIONS The evidence based medicine (EBM) is becoming ever more popular among spinal surgeons. Unfortunately this is not always feasible. Lack of uniform guidelines and numerous conflicts of interest introduce flaws in the decision making process. The key role of experts and professional societies is to provide high value recommendation based on the most current literature. Present work contains a set of guidelines for the surgical treatment of HLD officially endorsed by the Polish Spine Surgery Society.

Traumatic brain injury in Poland from 2009-2012: A national study on incidence.

Abstract Background: Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity worldwide. The purpose of this study was to provide data on epidemiology of TBI in Poland during 2009–2012. Methods: The national data on hospitalizations with TBI as a primary diagnosis was obtained from the National Health Fund of Poland. The sub-set of two diagnosis-related groups (DRG) was used for analysis. The incidence and mortality were calculated with the emphasis on diagnosis. The external causes of injuries were investigated based on the representative sample. Results: Within the study period there were 194 553 hospitalizations due to the TBI in two DRGs. The overall incidence was 126.52/105/year (95% CI = 125.96–127.09). The most common diagnosis was concussion, with an incidence of 81.66/105/year, and the most prevalent structural injury was subdural haematoma (15.27/105/year). The predominant external causes were traffic accidents (40.52%) followed by falls (32.77%). Conclusions: The incidence of TBIs in Poland compared with other countries in Europe is relatively low. The incidence of concussions mirrored current treatment guidelines rather than real epidemiology.

Accuracy of the Free-hand Placement of Pedicle Screws in the Lumbosacral Spine Using a Universal Entry Point: Clinical Validation.

Study Design: Retrospective radiographic study. Objective: To evaluate the accuracy of the free-hand placement of pedicle screws (PSs) using a new method of localization of entry points. Summary of Background Data: The PSs are essential in modern spinal surgery but their placement can be technically demanding. To improve this accuracy, numerous aids have been developed, some of them technologically advanced. Despite advances in technology the free-hand technique is still very popular. A simple geometric method of localization of entry points is proposed, designed to improved anatomic orientation. Methods: The radiographic and clinical data of 92 consecutive patients who underwent primary placement of PS in the lumbar spine were retrospectively analyzed. Postoperative computed tomography scans were used to assess the accuracy of screw placement using both quantitative and anatomic criteria. Results: A total of 85 patients with 410 screws were included in the study. Twenty screws were malpositioned, thus the overall accuracy was 95.12%. Of all levels instrumented the breach rate for the L1 level was highest (21.43%) and the difference was statistically significant. Two screws in 2 patients were symptomatic, causing radicular pain. Both underwent successful revisions. Conclusions: The proposed method of PS placement is safe and reliable for all levels from L2 to S1, with the accuracy similar to image-guided navigation systems.

Virtual Reality Based Simulators for Neurosurgeons - What We Have and What We Hope to Have in the Nearest Future

High levels of manual skills, good visual-motor coordination, excellent imagination and spatial awareness are the main factors determining the success of neurosurgeons. Proficiency in neurosurgical skills used to be acquired through hands-on training in cadaver labs and in real operating theatres under master neurosurgeon supervision. Most recently, virtual reality (VR) and augmented reality (AR) computer simulations have also been considered as tools for education in the neurosurgical training. The authors review existing solutions and present their own concept of a simulator which could become the useful tool for planning, simulation and training of a specific neurosurgical procedure using patient’s imaging data. The benefits of simulator are particularly apparent in the context of neurovascular operations. It is the field in which it is very difficult for young neurosurgeons to gain proficiency because of the lack of experience caused by the competition between microsurgery and endovascular techniques.

Treatment of degenerative cervical spondylosis with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

INTRODUCTION Degenerative cervical spondylosis (DCS) with radiculopathy is the most common indication for cervical spine surgery despite favorable natural history. Advances in spinal surgery in conjunction with difficulties in measuring the outcomes caused the paucity of uniform guidelines for the surgical management of DCS. AIMS The aim of this paper is to develop guidelines for surgical treatment of DCS. For this purpose the available up-to-date literature relevant on the topic was critically reviewed. METHODS AND RESULTS Six questions regarding most important clinical questions encountered in the daily practice were formulated. They were answered based upon the systematic literature review, thus creating a set of guidelines. The guidelines were categorized into four tiers based on the level of evidence (I-III and X). They were designed to assist in the selection of optimal and effective treatment leading to the most successful outcome. CONCLUSIONS The evidence based medicine (EBM) is increasingly popular among spinal surgeons. It allows making unbiased, optimal clinical decisions, eliminating the detrimental effect of numerous conflicts of interest. The key role of opinion leaders as well as professional societies is to provide guidelines for practice based on available clinical evidence. The present work contains a set of guidelines for surgical treatment of DCS officially endorsed by the Polish Spine Surgery Society.