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1.
Sariah Khormaee Andre M. Samuel William W. Schairer Peter B. Derman Alexander S. McLawhorn Michael C. Fu Todd J. Albert 《The spine journal》2019,19(3):430-436
BACKGROUND CONTEXT
Postdischarge care is a significant source of cost variability after posterior lumbar fusion surgery. However, there remains limited evidence associating postdischarge inpatient services and improved postoperative outcomes, despite the high cost of these services.PURPOSE
To determine the association between posthospital discharge to inpatient care facilities and postoperative complications.STUDY DESIGN
A retrospective review of all 1- to 3-level primary posterior lumbar fusion cases in the 2010-2014 National Surgical Quality Improvement Program registry was conducted. Propensity scores for discharge destination were determined based on observable baseline patient characteristics. Multivariable propensity-adjusted logistic regressions were performed to determine associations between discharge destination and postdischarge complications, with adjusted odds ratios (OR) and 95% confidence intervals (CI).RESULTS
A total of 18,652 posterior lumbar fusion cases were identified, 15,234 (82%) were discharged home, and 3,418 (18%) were discharged to continued inpatient care. Multivariable propensity-adjusted analysis demonstrated that being discharged to inpatient facilities was independently associated with higher risk of thromboembolic complications (OR [95% CI]: 1.79 [1.13–2.85]), urinary complications, (1.79 [1.27–2.51]), and unplanned readmissions (1.43 [1.22–1.68]).CONCLUSIONS
Discharge to continued inpatient care versus home after primary posterior lumbar fusion is independently associated with higher odds of certain major complications. To optimize clinical outcomes as well as cost savings in an era of value-based reimbursements, clinicians and hospitals should consider further investigation into carefully investigating which patients might be better served by home discharge after surgery. 相似文献2.
Shingo Morishita Toshitaka Yoshii Atsushi Okawa Kiyohide Fushimi Takeo Fujiwara 《The spine journal》2019,19(4):610-616
BACKGROUND CONTEXT
Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.PURPOSE
To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database.STUDY DESIGN
A retrospective cohort study with propensity score matching analysis.PATIENT SAMPLE
Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed.OUTCOME MEASURES
The occurrence of postoperative complications during hospitalization.METHODS
We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis.RESULTS
One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups.CONCLUSION
The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group. 相似文献3.
Background context
Lumbar pedicle screw placement can be technically challenging. Malpositioned screws occur in up to 15% of patients and could result in radiculopathy or instrumentation failure.Purpose
To compare intraoperative electromyography (EMG) and image guidance using an O-arm for identifying pedicle breach during elective lumbar fusion.Study design
Prospective observational study.Patient sample
All adult patients undergoing elective lumbar spinal fusion operations for degenerative spine disorders (including adjacent segment degeneration, degenerative scoliosis, and symptomatic spondylosis and spondylolisthesis) at a single institution from July 1, 2014, to December 1, 2015, were prospectively tracked.Outcome measures
Pedicle breach.Methods
Pedicle screws from L2–S1 were placed using C-arm assisted freehand technique. All screws were stimulated with EMG and evaluated using the O-arm intraoperative imaging system. Electromyography data were compared with intraoperative images to assess the accuracy of identifying pedicle breaches. No funding was received for this work.Results
One thousand six lumbar pedicles screws were placed from L2 to S1 in 164 consecutive cases. The mean patient age was 59.2 years. Thirty-five breaches (15 lateral and 20 medial) were visualized with O-arm imaging and confirmed by palpation (3.5% of screws placed). Of the breaches, 14 screws stimulated below the 12-mA threshold, nine screws stimulated between 12 and 20 mA, and 12 screws did not generate an EMG response. Forty screws stimulated below a 12-mA threshold but showed no breach on imaging. Using the 12-mA threshold, the sensitivity of EMG was 40%, specificity was 96%, positive predictive value was 26%, and negative predictive value was 98%. All 35 breached screws were corrected during surgery. There were no postoperative symptoms caused by breached screws and no patients required reoperation.Conclusions
Our findings indicate that EMG may not be a highly reliable tool in determining an anatomical breach during placement of lumbar pedicle screws. O-arm may be better for detecting either medial or lateral breaches than EMG stimulation if there are concerns about screw placement or for confirmation of placement before leaving the operating room. 相似文献4.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468
BACKGROUND CONTEXT
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.PURPOSE
To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.STUDY DESIGN/SETTING
Cross-sectional diagnostic study.PATIENT SAMPLE
Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP and TSE high bandwidth sequences).OUTCOME MEASURES
Sensitivity and specificity in detection of screw loosening for each imaging modality.METHODS
Screw torque force was measured intraoperatively and compared with preoperative screw loosening signs such as peri-screw edema in MRI and peri-screw osteolysis in CT and radiographs. A torque force of less than 60 Ncm was used to define a screw as loosened.RESULTS
Sensitivity and specificity in detection of screw loosening was 43.9% and 92.1% for MRI, 64.8% and 96.7% for CT, and 54.2% and 83.5% for standard radiographs, respectively.CONCLUSIONS
Despite improvement of MRI with metal artifact reduction MRI technique, CT remains the modality of choice. Even so, CT fails to detect all loosened pedicle screws. 相似文献5.
Carlo Ammendolia Y. Raja Rampersaud Danielle Southerst Aksa Ahmed Michael Schneider Gillian Hawker Claire Bombardier Pierre Côté 《The spine journal》2019,19(3):386-394
BACKGROUND CONTEXT
Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking.PURPOSE
The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS.STUDY DESIGN
This was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLE
We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURES
The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals.METHODS
Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years).RESULTS
Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was ?74 m (95% CI: ?282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5–1.3, p=.43).CONCLUSIONS
A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. 相似文献6.
Ishan Shah Christopher Wang Nick Jain Blake Formanek Zorica Buser Jeffrey C. Wang 《The spine journal》2019,19(4):662-669
BACKGROUND CONTEXT
Previous studies have found an association between mental illness and poor outcomes in spine surgery, but little is known about the effects of depression and/or anxiety on the adult spinal deformity population. In addition, most relevant studies exclusively focused on the lumbar spine and had relatively small patient sizes.PURPOSE
The aim of this study was to investigate whether adult spinal deformity patients with depression and/or anxiety have an increased risk of postoperative complications and reoperation following posterior thoracolumbar spinal surgery.STUDY DESIGN/SETTING
Retrospective database study.METHODS
Adult patients (over 18 years of age) with a diagnosis of spinal deformity undergoing any reconstructive thoracic or thoracolumbar spinal procedure with a posterior approach between 2007 and 2015 Q2 were identified using Current Procedural Terminology codes to query the Pearl Diver patient record database (Pearl Diver Technologies, West Conshohocken, PA, USA). The database includes records of approximately 18 million patients across the United States having Humana insurance. Further selection of patients with depression and/or anxiety and their associated postoperative complications were identified using ICD-9 and ICD-10 diagnosis codes (International Classification of Diseases 9th-10th edition). The mental illness cohort was matched to a control group according to age, sex, and Charlson Comorbidity Index. Patient data was analyzed for reoperation rates and incidence of common postoperative complications.RESULTS
Multilevel posterolateral fusion was the most common included posterior thoracic reconstructive surgery. The mental illness cohort (n?=?327) had significantly increased rates of infection (odds ratio [OR]?=?1.743, p = .022) and respiratory complications (OR?=?1.492, p = .02) at the 90-day postoperative period. The rates of incision and drainage (OR?=?1.379, p = .475) and pneumonia (OR?=?1.22, p = .573) were increased in the mental illness cohort at the 90-day postoperative period, but not significantly. There were no significant differences in complication and reoperation rates at 1-year postoperatively.CONCLUSIONS
Patients with spinal deformity and pre-existing depression and/or anxiety treated with a posterior thoracolumbar reconstructive spinal surgery had significantly elevated risk of postoperative infections and respiratory complications when compared with the control group. 相似文献7.
Charles H. Crawford Steven D. Glassman Mladen Djurasovic R. Kirk Owens Jeffrey L. Gum Leah Y. Carreon 《The spine journal》2019,19(2):187-190
BACKGROUND CONTEXT
Previous studies suggest that a postoperative symptom state with Oswestry Disability Index (ODI)≤20 and pain Numeric Rating Scales (NRS)≤2 following surgery for lumbar degenerative conditions are reasonable thresholds for best outcomes in which patients will be unlikely to seek additional medical care or require additional health-care resources.PURPOSE
To identify prognostic factors that predict a “best outcome,” defined as postoperative ODI≤20 and pain NRS≤2 following fusion for lumbar degenerative conditions.STUDY DESIGN
Longitudinal observational cohort.PATIENT SAMPLE
A total of 396 patients from a single site enrolled in the Quality Outcomes Database who underwent fusion for lumbar degenerative conditions.Outcome Measures
Oswestry Disability Index, Back and Leg Pain NRS (0–10).METHODS
Collected and analyzed variables included age, sex, body mass index, American Society of Anesthesia grade, number of surgical levels, surgical time, preoperative ODI, preoperative back pain, preoperative leg pain, workmen compensation status, surgical approach, smoking status, and principal diagnosis.RESULTS
A total of 74 patients (19%) reported a minimal symptom state at 1-year postoperative (ODI≤20, back pain NRS≤2, and leg pain NRS≤2) and were included in the best outcomes group. Patients in the best outcomes group were older (62 vs. 57 years, p=.001), had lower preoperative ODI (43 vs. 56, p=.000), lower preoperative back pain (6.5 vs. 7.5, p=.000). They had fewer surgical levels (1.25 vs. 1.47, p=.005) and shorter operative times [OR] times (208 vs. 241 minutes, p=.002). They were more likely to have a preoperative diagnosis of spondylolisthesis or disc herniation and less likely to have a diagnosis of adjacent segment disease or mechanical disc collapse (p=.001). Stepwise forward regression analysis revealed diagnosis (p=.023, OR=0.75), age (p=.000, OR=1.04), baseline ODI (p=.000, OR=0.96), and number of levels (p=.019, OR=0.53) as predictive variables.CONCLUSION
Achieving a minimal symptom state, defined here as a postoperative ODI≤20 and pain NRS≤2, following fusion for lumbar degenerative conditions is more likely in an older patient with a lower baseline ODI undergoing a single level lumbar fusion for spondylolisthesis. 相似文献8.
Xiang Yu Ben Wang ShaoMin Yang SongBo Han Liang Jiang XiaoGuang Liu Feng Wei FengLiang Wu Lei Dang ZhongJun Liu 《The spine journal》2019,19(3):509-515
BACKGROUND CONTEXT
Both open surgical resection (OSR) and radiofrequency ablation (RFA) have been reported for spinal osteoid osteoma (OO).PURPOSE
To verify the clinical safety and efficiency of RFA with OSR in treating spinal OO.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Twenty-eight consecutive patients with spinal OO who underwent either RFA or OSR in our institute between September 2006 and December 2016.OUTCOME MEASURES
The age, gender, lesion distribution, surgical time, estimated blood loss, complications, local recurrence, visual analogue scale (VAS), and the modified Frankel grade were documented.METHODS
We retrospectively reviewed 28 patients with spinal OO who had been treated in our hospital from September 2006 to December 2016. Patients were followed at 3, 6, 12, and 24 months after the index surgery. The minimum follow-up period was 12 months. This study was funded by Peking University Third Hospital (Y71508-01) (¥ 400,000).RESULTS
Twelve and 16 patients were treated with CT-guided percutaneous RFA and OSR, respectively. Spinal OO locations were cervical in 4, thoracic in 4, lumbar in 3, and sacral vertebra in 1 in the RFA group and cervical in 12, thoracic in 1, and lumber in 3 in the OSR group. RFA showed shorter operating time, less blood loss, and less in-hospital stay than open surgery [105.0 ± 33.8 minutes vs. 186.4 ± 53.5 minutes (p < .001), 1 (0 to 5) ml vs. 125 (30–1200) ml (p < .001) and 1 (1–3) days vs. 6 (3–10) days (p < .001), respectively]. At last follow-up, one patient underwent a secondary RFA for recurrence. VAS improvement was 7.5 (3–10) and 6.5 (4–9) (p = .945) in the RFA and OSR groups, respectively. The overall complication rate was 8.3% (1/12) and 18.8% (3/16) in the RFA and OSR groups, respectively.CONCLUSIONS
If there is sufficient cerebrospinal fluid between the spinal OO lesion and spinal cord/nerve root (more than 1 mm), RFA is effective and safe for treatment of well-selected spinal OO, showing reduced operating time, blood loss, in-hospital stay, and complications compared to OSR. However, OSR is still recommended in cases with spinal cord/nerve root compression. 相似文献9.
Stephan N. Salzmann Toshiyuki Shirahata Jingyan Yang Courtney Ortiz Miller Brandon B. Carlson Colleen Rentenberger John A. Carrino Jennifer Shue Andrew A. Sama Frank P. Cammisa Federico P. Girardi Alexander P. Hughes 《The spine journal》2019,19(4):695-702
BACKGROUND CONTEXT
Quantitative computed tomography (QCT) of the lumbar spine is used as an alternative to dual-energy X-ray absorptiometry in assessing bone mineral density (BMD). The average BMD of L1-L2 is the standard reportable metric used for diagnostic purposes according to current recommendations. The density of L1 and L2 has also been proposed as a reference value for the remaining lumbosacral vertebrae and is commonly used as a surrogate marker for overall bone health. Since regional BMD differences within the spine have been proposed, it is unclear if the L1-L2 average correlates with the remainder of the lumbosacral spine.PURPOSE
The aim of this study was to determine possible BMD variations throughout the lumbosacral spine in patients undergoing lumbar fusion and to assess the correlation between the clinically used L1-L2 average and the remaining lumbosacral vertebral levels.STUDY DESIGN/SETTING
This is a retrospective case series.PATIENT SAMPLE
Patients undergoing posterior lumbar spinal fusion from 2014 to 2017 at a single, academic institution with available preoperative CT imaging were included in this study.OUTCOME MEASURES
The outcome measure was BMD measured by QCT.METHODS
Standard QCT measurements at the L1 and L2 vertebra and additional experimental measurements of L3, L4, L5, and S1 were performed. Subjects with missing preoperative lumbar spine CT imaging were excluded. The correlations between the L1-L2 average and the other vertebral bodies of the lumbosacral spine (L3, L4, L5, S1) were evaluated.RESULTS
In total, 296 consecutive patients (55.4% female, mean age of 63.1 years) with available preoperative CT were included. The vertebral BMD values showed a gradual decrease from L1 to L3 and increase from L4 to S1 (L1=118.8 mg/cm3, L2=116.6 mg/cm3, L3=112.5 mg/cm3, L4=122.4 mg/cm3, L5=135.3 mg/cm3, S1=157.4 mg/cm3). There was strong correlation between the L1-L2 average and the average of the other lumbosacral vertebrae (L3-S1) with a Pearson's correlation coefficient (r=0.85). We also analyzed the correlation between the L1-L2 average and each individual lumbosacral vertebra. Similar relationships were observed (r value, 0.67–0.87), with the strongest correlation between the L1-L2 average and L3 (r=0.87).CONCLUSIONS
Our data demonstrate regional BMD differences throughout the lumbosacral spine. Nevertheless, there is high correlation between the clinically used L1-L2 average and the BMD values in the other lumbosacral vertebrae. We, therefore, conclude the standard clinically used L1-L2 BMD average is a useful bone quantity measure of the entire lumbosacral spine in patients undergoing lumbar spinal fusion. 相似文献10.
Jeremy A. Lieberman Russ Lyon Paul Jasiukaitis Sigurd H. Berven Shane Burch John Feiner 《The spine journal》2019,19(3):377-385
STUDY DESIGN
Case-control analysis of transcranial motor evoked potential (MEP) responses and clinical outcome.OBJECTIVE
To determine the sensitivity and specificity of MEPs to predict isolated nerve root injury causing dorsiflexion weakness in selected patients having complex lumbar spine surgery.SUMMARY OF BACKGROUND DATA
The surgical correction of distal lumbar spine deformity involves significant risk for damage to neural structures that control muscles of ankle and toe dorsiflexion. Procedures often include vertebral translation, interbody fusion, and posterior-based osteotomies. The benefit of using MEP monitoring to predict dorsiflexion weakness has not been well-established. The purpose of this paper is to describe the relationship between neural complications from lumbar surgery and intraoperative MEP changes.METHODS
Included were 542 neurologically intact patients who underwent posterior spinal fusion for the correction of distal lumbar deformity. Two myotomes, including tibialis anterior (TA) and extensor hallucis longus (EHL), were monitored. MEP and free-running electromyography data were assessed in each patient. Cases of new dorsiflexion weakness noted postoperatively were identified. Data in case and control patients were compared. There was no direct funding for this work. The Department of Anesthesiology and Perioperative Care provides salary support for authors one and six. Authors two and three report employment in the field of intraoperative neurophysiological monitoring as a study-specific conflict of interest.RESULTS
Twenty-five patients (cases) developed dorsiflexion weakness. MEP amplitude decreased in the injured myotomes by an average of 65 ± 21% (TA) and 60±26% (EHL), which was significantly greater than the contralateral uninjured side or for control subjects. (p < .01) Receiver operator characteristic (ROC) curves showed high sensitivity, specificity, and predictive value for changes in MEP amplitude using either the TA or EHL. Analysis of MEP changes to either TA or EHL yielded a superior ROC curve. Net reclassification improvement analysis showed assessing MEP changes to both TA and EHL improved the predictability of injury.CONCLUSIONS
The use of MEP amplitude change is highly sensitive and specific to predict a new postoperative dorsiflexion injury. Monitoring two myotomes (both TA and EHL) is superior to relying on MEP changes from a single myotome. Electromyography activity was less accurate but compliments MEP use. Additional studies are needed to define optimal intraoperative MEP warning thresholds. 相似文献11.
P. Endler P. Ekman H. Ljungqvist T.B. Brismar P. Gerdhem H. Möller 《The spine journal》2019,19(3):501-508
BACKGROUND CONTEXT
Data on the long-term outcome after fusion for isthmic spondylolisthesis are scarce.PURPOSE
To study patient-reported outcomes and adjacent segment degeneration (ASD) after fusion for isthmic spondylolisthesis and to compare patient-reported outcomes with a control group.STUDY DESIGN/SETTING
A prospective study including a cross-sectional control group.PATIENT SAMPLE
Patients with isthmic spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) (n=86) or posterolateral fusion (PLF) (n=77). Patient-reported outcome data were available for 73 patients in the PLIF group and 71 in the PLF group at a mean of 11 (range 5–16) years after baseline. Seventy-seven patients in the PLIF group and 54 in the PLF group had radiographs at a mean of 14 (range 9–19) years after baseline. One hundred thirty-six randomly selected persons from the population served as controls for the patient-reported outcomes.OUTCOME MEASURES
Patient-reported outcomes include the following: global outcome, Oswestry Disability Index, Disability Rating Index, and Short Form 36. The ASD was determined from radiographs using the University of California Los Angeles (UCLA) grading scale.METHODS
: The chi-square test or analysis of covariance (ANCOVA) was used for group comparisons. The ANCOVA was adjusted for follow-up time, smoking, Meyerding slippage grade, teetotaler (yes/no) and, if available, the baseline level of the dependent variable.RESULTS
There were no significant patient-reported outcome differences between the PLIF group and the PLF group. The prevalence of ASD was 42% (32/77) in the PLIF group and 26% (14/54) in the PLF group (p=.98). The patient-reported outcome data indicated lower physical function and more pain in individuals with surgically treated isthmic spondylolisthesis compared to the controls.CONCLUSIONS
PLIF and PLF groups had similar long-term patient-reported and radiological outcomes. Individuals with isthmic spondylolisthesis have lower physical function and more pain several years after surgery when compared to the general population. 相似文献12.
Man-Kyu Park Kyoung-Tae Kim Woo-Seok Bang Dae-Chul Cho Joo-Kyung Sung Young-Seok Lee Chang Kyu Lee Chi Heon Kim Brian K. Kwon Won-Kee Lee Inbo Han 《The spine journal》2019,19(3):437-447
BACKGROUND CONTEXT
Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure, but cage migration (CM) and cage retropulsion (CR) are associated with poor outcomes.PURPOSE
This study seeks to identify risk factors associated with these serious events.STUDY DESIGN
A prospective observational longitudinal study.PATIENT SAMPLE
Over a 5-year period, 881 lumbar levels in 784 patients were treated using TLIF at three spinal surgery centers.OUTCOME MEASURES
We evaluated the odds ratio of the risk factors for CM with and without subsidence and CR in multivariate analysis.METHODS
Our study classified CM into two subgroups: CM without subsidence and CM with subsidence. Cases of spinal canal and/or foramen intrusion of the cage was defined separately as CR. Patient records, operative notes, and radiographs were analyzed for factors potentially related to CM with subsidence, CM without subsidence, and CR.RESULTS
Of 881 lumbar levels treated with TLIFs, CM without subsidence was observed in 20 (2.3%) and CM with subsidence was observed in 36 (4.1%) patients. Among the CM cases, CR was observed in 17 (17/56, 30.4%). The risk factors of CM without subsidence were osteoporosis (OR 8.73, p < .001) and use of a unilateral single cage (OR 3.57, p < .001). Osteoporosis (OR 5.77, p < .001) and endplate injury (OR 26.87, p < .001) were found to be significant risk factors for CM with subsidence. Risk factors of CR were osteoporosis (OR 7.86, p < .001), pear-shaped disc (OR 8.28, p = .001), endplate injury (OR 18.70, p < .001), unilateral single cage use (OR 4.40, p = .03), and posterior cage position (OR 6.45, p = .04). A difference in overall fusion rates was identified, with a rate of 97.1% (801 of 825) for no CM, 55.0% (11 of 20) for CM without subsidence, 41.7% (15 of 36) for CM with subsidence, and 17.6% (3 of 17) for CR at 1.5 years postoperatively.CONCLUSIONS
Our results suggest that osteoporosis is a significant risk factor for both CM and CR. In addition, a pear-shaped disc, posterior positioning of the cage, the presence of endplate injury and the use of a single cage were correlated with the CM with and without subsidence and CR. 相似文献13.
Masashi Uehara Jun Takahashi Shota Ikegami Ryosuke Tokida Hikaru Nishimura Noriko Sakai Hiroyuki Kato 《The spine journal》2019,19(2):349-356
BACKGROUND CONTEXT
It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.OBJECTIVES
In this study of an aged Japanese population, we employed random sampling from the basic resident registry of a rural town for subject selection to determine reference values of sagittal spinal alignment including the cervical spine.STUDY DESIGN
Japanese resident cohort study based on a municipal registry.PATIENT SAMPLE
A total of 413 aged people randomly sampled from the resident registry of a rural Japanese town.OUTCOME MEASURES
All subjects underwent a whole spine lateral radiograph for measurement of sagittal spinal alignment parameters.METHODS
Registered citizens of 50 to 89 years old were targeted for this survey. We established eight groups based on age (50s, 60s, 70s, and 80s) and gender (male and female) after random sampling from the resident registry of Obuse town in 2014. A total of 413 people (203 males and 210 females) were enrolled. Radiographic parameters of sagittal spinal alignment of the cohort were measured and analyzed. Funding for this study was provided by the Japan Orthopaedics and Traumatology Research Foundation (10,000 USD), the Japanese Orthopaedic Association (5,000 USD), the Japanese Society for Musculoskeletal Medicine (40,000 USD), and the Nakatomi Foundation (15,000 USD).RESULTS
Global spinal alignments became more misaligned with age for both genders. Sagittal vertical axis (SVA) forward shift was significantly more frequent in 80s males and 70s females, and SVA in 80s females was a mean of 66 mm forward of that of 50s females. Cervical protrusion was markedly greater in 60s males onwards. In women, lumbar lordosis and posterior pelvic inclination were noticeable from a younger age than in men. The amount of pelvic tilt misalignment in female subjects was approximately 10 years earlier than their male counterparts.CONCLUSIONS
This first resident cohort of Japanese individuals determined average spinal alignment parameters by age and gender. Spinal balance generally shifts forward as age increases. A forward shift in the upper cervical spine occurs first in men, whereas lumbopelvic alignment shift occurs first in women. 相似文献14.
Victor E. Staartjes Alessandro Siccoli Marlies P. de Wispelaere Marc L. Schröder 《The spine journal》2019,19(4):637-644
BACKGROUND
In modern clinical research, the accepted minimum follow-up for patient-reported outcome measures (PROMs) after lumbar spine surgery is 24 months, particularly after fusion. Recently, this minimum requirement has been called into question.PURPOSE
We aim to quantify the concordance of 1- and 2-year PROMs to evaluate the importance of long-term follow-up after elective lumbar spine surgery.STUDY DESIGN
Retrospective analysis of data from a prospective registry.PATIENT SAMPLE
We identified all patients in our prospective institutional registry who underwent degenerative lumbar spine surgery with complete baseline, 12-month, and 24-month follow-up for ODI and numeric rating scales for back and leg pain (NRS-BP and NRS-LP).OUTCOME MEASURES
Oswestry Disability Index (ODI) and NRS-BP and NRS-LP at 1 year and at 2 years.METHODS
We evaluated concordance of 1- and 2-year change scores by means of Pearson's product-moment correlation and performed logistic regression to assess if achieving the minimum clinically important difference (MCID) at 12 months predicted 24-month MCID. Odds ratios (OR) and their 95% confidence intervals (CI), as well as model areas-under-the-curve were obtained.RESULTS
A total of 210 patients were included. We observed excellent correlation among 12- and 24-month ODI (r?=?0.88), NRS-LP (r?=?0.76) and NRS-BP (r?=?0.72, all p <.001). Equal results were obtained when stratifying for discectomy, decompression, or fusion. Patients achieving 12-month MCID were likely to achieve 24-month MCID for ODI (OR: 3.3, 95% CI: 2.4–4.1), NRS-LP (OR: 2.99, 95% CI: 2.2–4.2) and NRS-BP (OR: 3.4, 95% CI: 2.7–4.2, all p <.001) with excellent areas-under-the-curve values of 0.81, 0.77, and 0.84, respectively. Concordance rates between MCID at both follow-ups were 87.2%, 83.8%, and 84.2%. A post-hoc power analysis demonstrated sufficient statistical power.CONCLUSIONS
Irrespective of the surgical procedure, 12-month PROMs for functional disability and pain severity accurately reflect those at 24 months. In support of previous literature, our results suggest that 12 months of follow-up may be sufficient for evaluating spinal patient care in clinical practice as well as in research. 相似文献15.
Andrew J. Schoenfeld Daniel J. Sturgeon Justin A. Blucher Adil H. Haider James D. Kang 《The spine journal》2019,19(1):8-14
BACKGROUND CONTEXT
The impact of Accountable Care Organizations (ACOs) on healthcare quality and outcomes, including morbidity, mortality, and readmissions, has not been substantially investigated, especially following spine surgery.PURPOSE
To evaluate the impact of ACO formation on postoperative outcomes in the 90-day period following spine surgery.STUDY DESIGN
Retrospective review of national Medicare claims data (2009–2014).PATIENT SAMPLE
Patients who underwent one of four lumbar spine surgical procedures in an ACO or non-ACO.OUTCOME MEASURES
The development of in-hospital mortality, complications or hospital readmission within 90 days of the surgical procedure.METHODS
The primary outcome measures included postsurgical complications and readmissions at 90 days following surgery. In-hospital mortality and 30-day outcomes were considered secondarily. The primary predictor variable consisted of ACO enrollment designation. Multivariable logistic regression analysis was utilized to adjust for confounders and determine the independent effect of ACO enrollment on postsurgical outcomes. The multivariable model included a propensity score adjustment that accounted for factors associated with the preferential enrollment of patients in ACOs, namely, sociodemographic characteristics, medical co-morbidities, hospital teaching status, bed size, and location.RESULTS
In all, there were 344,813 patients identified for inclusion in this analysis with 97% (n = 332,890) treated in non-ACOs and 3% (n = 11,923) in an ACO. Although modest changes were apparent across both ACOs and non-ACOs over the time-period studied, improvements were slightly more dramatic in non-ACOs leading to statistically significant differences in both 90-day complications and readmissions. Specifically, in the period 2012–2014, ACOs demonstrated an 18% increase in the odds of 90-day complications and a 14% elevation in the odds of 90-day readmissions when compared to non-ACOs. There was no difference in hospital mortality between ACOs and non-ACOs.CONCLUSIONS
Our study of Medicare data from 2009 to 2014 failed to demonstrate superior reductions in postoperative morbidity, mortality, and readmissions for beneficiaries treated in ACOs as compared to non-ACOs. These results indicate that meaningful changes in postoperative outcomes should not be anticipated based on organizational participation in ACOs at present. 相似文献16.
Jayme C.B. Koltsov Matthew W. Smuck Alicia Zagel Todd F. Alamin Kirkham B. Wood Ivan Cheng Serena S. Hu 《The spine journal》2019,19(2):199-205
Background Context
Lumbosacral epidural steroid injections (ESIs) have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI.Purpose
The purpose of this research was to determine the proportion of patients having surgery after lumbar ESI for disc herniation or stenosis and to identify the timing and factors associated with this progression.Study Design/Setting
This study was a retrospective review of nationally representative administrative claims data from the Truven Health MarketScan databases from 2007 to 2014.Patient Sample
The study cohort was comprised of 179,025 patients (54±15 years, 48% women) having lumbar ESIs for diagnoses of stenosis and/or herniation.Outcome Measures
The primary outcome measure was the time from ESI to surgery.Methods
Inclusion criteria were ESI for stenosis and/or herniation, age ≥18 years, and health plan enrollment for 1 year before ESI to screen for exclusions. Patients were followed longitudinally until they progressed to surgery or had a lapse in enrollment, at which time they were censored. Rates of surgery were assessed with the Kaplan–Meier survival curves. Demographic and treatment factors associated with surgery were assessed with multivariable Cox proportional hazard models. No external funding was procured for this research and the authors' conflicts of interest are not pertinent to the present work.Results
Within 6 months, 12.5% of ESI patients underwent lumbar surgery. By 1 year, 16.9% had surgery, and by 5 years, 26.1% had surgery. Patients with herniation had surgery at rates of up to five-fold to seven-fold higher, with the highest rates of surgery in younger patients and those with both herniation and stenosis. Other concomitant spine diagnoses, male sex, previous tobacco use, and residence a rural areas or regions other than the Northeastern United States were associated with higher surgery rates. Medical comorbidities (previous treatment for drug use, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypercholesterolemia, and other cardiac complications) were associated with lower surgery rates.Conclusions
In the long term, more than one out of every four patients undergoing ESI for lumbar herniation or stenosis subsequently had surgery, and nearly one of six had surgery within the first year. After adjusting for other patient demographics and comorbidities, patients with herniation were more likely have surgery than those with stenosis. The improved understanding of the progression from lumbar ESI to surgery will help to better inform discussions regarding the value of ESI and aid in the shared decision-making process. 相似文献17.
Sung Hyun Noh Kyung Hyun Kim Dong Ah Shin Jeong Yoon Park Seong Yi Sung Uk Kuh Keung Nyun Kim Dong Kyu Chin Keun Su Kim Do Heum Yoon Yong Eun Cho 《The spine journal》2019,19(2):276-284
BACKGROUND CONTEXT
Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases.PURPOSE
The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors.STUDY DESIGN
A retrospective chart review was performed.PATIENT SAMPLE
We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma.OUTCOME MEASURES
We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy.METHODS
The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared.RESULTS
Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05).CONCLUSIONS
Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered. 相似文献18.
BACKGROUND CONTEXT
The kinematics of the lumbar region and the activation patterns of the erector spinae muscle have been associated with the genesis of low back pain, which is one of the most common complications associated with pregnancy. Despite the high prevalence of pregnancy-related low back pain, the biomechanical adaptations of the lumbar region during pregnancy remain unknown.PURPOSE
This study analyzes lumbar spine motion and the activation pattern of the lumbar erector spinae muscle in healthy pregnant women.STUDY DESIGN
A case-control study.PATIENT SAMPLE
The study involved 34 nulliparous women (control group) and 34 pregnant women in the third trimester (week 36 ± 1).OUTCOME MEASURES
We recorded the parameters of angular displacement of the lumbar spine in the sagittal plane during trunk flexion-extension, and the EMG activity of the erector spinae muscles during flexion, extension, eccentric and concentric contractions, and the myolectrical silence.METHODS
The participants performed several series of trunk flexion-extension movements, which were repeated 2 months postpartum. The position of the lumbar spine was recorded using an electromagnetic motion capture system. EMG activity was recorded by a surface EMG system and expressed as a percentage of a submaximal reference contraction.RESULTS
Antepartum measurements showed a decrease (relative to control and postpartum measurements) in lumbar maximum flexion (52.5 ± 10.5° vs 57.3 ± 7.7° and 58.7 ± 8.6°; p < .01), the percentage of lumbar flexion during forward bending (56.4 ± 5.6% vs 59.4 ± 6.8% and 59.7 ± 5.6%; p < .01), and the time keeping maximum levels of lumbar flexion (35.7 ± 6.7% vs 43.8 ± 5.3% and 50.1 ± 3.7%; p < .01). Higher levels of erector spinae activation were observed in pregnant women during forward bending (10.1 ± 4.8% vs 6.3 ± 2.4% and 6.6 ± 2.7%; p < .01) and eccentric contraction (12.1 ± 5.2% vs 9.4 ± 3.1% and 9.1 ± 2.9%; p < .01), as well as a shortened erector spinae myoelectric silence during flexion.Conclusions
Pregnant women show adaptations in their patterns of lumbar motion and erector spinae activity during trunk flexion-extension. These changes could be associated with the genesis of pregnancy-related low back pain, by means of biomechanical protection mechanisms against the increase on abdominal mass and ligamentous laxity. 相似文献19.
Mark Shasti Scott J. Koenig Alysa B. Nash Shahrzad Bahrami Julio J. Jauregui Nathan N. O&#x;Hara Ehsan Jazini Daniel E. Gelb Steven C. Ludwig 《The spine journal》2019,19(3):545-551
BACKGROUND CONTEXT
Adjacent segment disease (ASD) is a well-known complication after lumbar fusion. Lumbar lateral interbody fusion (LLIF) may provide an alternative method of treatment for ASD while avoiding the morbidity associated with revision surgery through a traditional posterior approach. This is the first biomechanical study to evaluate the stability of lateral-based constructs for treating ASD in existing multilevel fusion model.PURPOSE
We aimed to evaluate the biomechanical stability of anterior column reconstruction through the less invasive lateral-based interbody techniques compared with traditional posterior spinal fusion for the treatment of ASD in existing multilevel fusion.STUDY DESIGN/SETTING
Cadaveric biomechanical study of laterally based interbody strategies for treating ASD.METHODS
Eighteen fresh-frozen cadaveric specimens were nondestructively loaded in flexion, extension, and lateral bending. The specimens were randomized into three different groups according to planned posterior spinal instrumented fusion (PSF): group 1: L5–S1, group 2: L4–S1, and group 3: L3–S1. In each group, ASD was considered the level cranial to the upper-instrumented vertebrae (UIV). After testing the intact spine, each specimen underwent PSF representing prior fusion in the ASD model. The adjacent segment for each specimen then underwent (1) Stand-alone LLIF, (2) LLIF?+?plate, (3) LLIF?+?single screw rod (SSR) anterior instrumentation, and (4) LLIF?+?traditional posterior extension of PSF. In all conditions, three-dimensional kinematics were tracked, and range of motion (ROM) was calculated for the comparisons.RESULTS
ROM results were expressed as a percentage of the intact spine ROM. LLIF effectively reduces ROM in all planes of ROM. Supplementation of LLIF with plate or SSR provides further stability as compared with stand-alone LLIF. Expansion of posterior instrumentation provides the most substantial stability in all planes of ROM (p <.05). All constructs demonstrated a consistent trend of reduction in ROM between all the groups in all bending motions.CONCLUSIONS
This biomechanical study suggests potential promise in exploring LLIF as an alternative treatment of ASD but reinforces previous studies' findings that traditional expansion of posterior instrumentation provides the most biomechanically stable construct. 相似文献20.
John T. Tsiang Tyler G. Kinzy Nicolas Thompson Joseph E. Tanenbaum Nitya L. Thakore Tagreed Khalaf Irene L. Katzan 《The spine journal》2019,19(2):293-300