Search Results

You are looking at 1 - 2 of 2 items for

  • Author or Editor: Jiwon Park x
  • Refine by Access: all x
Clear All Modify Search
Restricted access

Dae-Woong Ham, Ho-Joong Kim, Sang-Min Park, Se Jin Park, Jiwon Park, and Jin S. Yeom

OBJECTIVE

Changes in the thoracolumbar angle (TLA) would play a pivotal role in the reciprocal changes following spine realignment surgery, thereby leading to the development of proximal junctional kyphosis (PJK). This study aimed to investigate the association between TLA and the development of PJK following adult spinal deformity surgery.

METHODS

A total of 107 patients were divided into PJK+ and PJK− groups according to the development of PJK within 12 months after surgery. The TLA and spinopelvic radiological parameters were compared between the PJK+ and PJK− groups. A multivariate logistic regression model was used to identify the risk factors for PJK. The receiver operating characteristic curves of the regression models were used to investigate the cutoff values of significant parameters needed so that PJK would not occur.

RESULTS

The change in TLA (ΔTLA) in the PJK+ group was significantly larger than in the PJK− group (6.7° ± 7.9° and 2.2° ± 8.1°, respectively; p = 0.006). Multivariate logistic regression analysis demonstrated that age, postoperative pelvic incidence–lumbar lordosis, and ΔTLA were significant risk factors for PJK. The risk of developing PJK was higher when the postoperative pelvic incidence–lumbar lordosis was < 5.2 and the ΔTLA was > 3.58°.

CONCLUSIONS

The present study highlights the thinking that extensive correction of TLA and lumbar lordosis should be avoided in patients with adult spinal deformity. Overcorrection of TLA of > 3.58° could result in higher odds of PJK.

Free access

Sharath Kumar Anand, William J. Benjamin IV, Arjun Rohit Adapa, Jiwon V. Park, D. Andrew Wilkinson, Badih J. Daou, James F. Burke, and Aditya S. Pandey

OBJECTIVE

The establishment of mechanical thrombectomy (MT) as a first-line treatment for select patients with acute ischemic stroke (AIS) and the expansion of stroke systems of care have been major advancements in the care of patients with AIS. In this study, the authors aimed to identify temporal trends in the usage of tissue-type plasminogen activator (tPA) and MT within the AIS population from 2012 to 2018, and the relationship to mortality.

METHODS

Using a nationwide private health insurance database, 117,834 patients who presented with a primary AIS between 2012 and 2018 in the United States were identified. The authors evaluated temporal trends in tPA and MT usage and clinical outcomes stratified by treatment and age using descriptive statistics.

RESULTS

Among patients presenting with AIS in this population, the mean age was 69.1 years (SD ± 12.3 years), and 51.7% were female. Between 2012 and 2018, the use of tPA and MT increased significantly (tPA, 6.3% to 11.8%, p < 0.0001; MT, 1.6% to 5.7%, p < 0.0001). Mortality at 90 days decreased significantly in the overall AIS population (8.7% to 6.7%, p < 0.0001). The largest reduction in 90-day mortality was seen in patients treated with MT (21.4% to 14.1%, p = 0.0414) versus tPA (11.8% to 7.0%, p < 0.0001) versus no treatment (8.3% to 6.3%, p < 0.0001). Age-standardized mortality at 90 days decreased significantly only in patients aged 71–80 years (11.4% to 7.8%, p < 0.0001) and > 81 years (17.8% to 11.6%, p < 0.0001). Mortality at 90 days stagnated in patients aged 18 to 50 years (3.0% to 2.2%, p = 0.4919), 51 to 60 years (3.8% to 3.9%, p = 0.7632), and 61 to 70 years (5.5% to 5.2%, p = 0.2448).

CONCLUSIONS

From 2012 to 2018, use of tPA and MT increased significantly, irrespective of age, while mortality decreased in the entire AIS population. The most dramatic decrease in mortality was seen in the MT-treated population. Age-standardized mortality improved only in patients older than 70 years, with no change in younger patients.