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1.
Background Context
Short-term readmission rates are becoming widely used as a quality and performance metric for hospitals. Data on unplanned short-term readmission after spine fusion for deformity in pediatric patients are limited.Purpose
To characterize the rate and risk factors for short-term readmission after spine fusion for deformity in pediatric patients.Study Design
This is a retrospective cohort study.Patient Sample
Data were obtained from the State Inpatient Database from New York, Utah, Nebraska, Florida, North Carolina (years 2006–2010), and California (years 2006–2011).Outcome Measures
Outcome measures included 30- and 90-day readmission rates.Materials and Methods
Inclusion criteria were patients aged 0–21 years, a primary diagnosis of spine deformity, and a primary 3+-level lumbar or thoracic fusion. Exclusion criteria included revision surgery at index admission and cervical fusion. Readmission rates were calculated and logistic analyses were used to identify independent predictors of readmission.Results
There were a total of 13,287 patients with a median age of 14 years. Sixty-seven percent were girls. The overall 30- and 90-day readmission rates were 4.7% and 6.1%. The most common reasons for readmission were infection (38% at 30 days and 33% at 90 days), wound dehiscence (19% and 17%), and pulmonary complications (12% and 13%). On multivariate analysis, predictors of 30-day readmission included male sex (p=.008), neuromuscular (p<.0001) or congenital scoliosis (p=.006), Scheuermann kyphosis (p=.003), Medicaid insurance (p<.0001), length of stay of ≤3 days or ≥6 days (p<.0001), and surgery at a teaching hospital (p=.011). Surgery at a hospital performing >80 operations/year was associated with a 34% reduced risk of 30-day readmission (95% confidence interval 12%-50%, p=.005) compared with hospitals performing <20 operations/year.Conclusions
The short-term readmission rate for pediatric spine deformity surgery is driven by patient-related factors, as well as several risk factors that may be modified to reduce this rate. 相似文献2.
Ho-Joong Kim Kyoung-Tak Kang Sung-Cheol Park Oh-Hyo Kwon Juhyun Son Bong-Soon Chang Choon-Ki Lee Jin S. Yeom Lawrence G. Lenke 《The spine journal》2017,17(5):671-680
Background Context
There have been conflicting results on the surgical outcome of lumbar fusion surgery using two different techniques: robot-assisted pedicle screw fixation and conventional freehand technique. In addition, there have been no studies about the biomechanical issues between both techniques.Purpose
This study aimed to investigate the biomechanical properties in terms of stress at adjacent segments using robot-assisted pedicle screw insertion technique (robot-assisted, minimally invasive posterior lumbar interbody fusion, Rom-PLIF) and freehand technique (conventional, freehand, open approach, posterior lumbar interbody fusion, Cop-PLIF) for instrumented lumbar fusion surgery.Study Design
This is an additional post-hoc analysis for patient-specific finite element (FE) model.Patient Sample
The sample is composed of patients with degenerative lumbar disease.Outcome Measures
Intradiscal pressure and facet contact force are the outcome measures.Methods
Patients were randomly assigned to undergo an instrumented PLIF procedure using a Rom-PLIF (37 patients) or a Cop-PLIF (41), respectively. Five patients in each group were selected using a simple random sampling method after operation, and 10 preoperative and postoperative lumbar spines were modeled from preoperative high-resolution computed tomography of 10 patients using the same method for a validated lumbar spine model. Under four pure moments of 7.5?Nm, the changes in intradiscal pressure and facet joint contact force at the proximal adjacent segment following fusion surgery were analyzed and compared with preoperative states.Results
The representativeness of random samples was verified. Both groups showed significant increases in postoperative intradiscal pressure at the proximal adjacent segment under four moments, compared with the preoperative state. The Cop-PLIF models demonstrated significantly higher percent increments of intradiscal pressure at proximal adjacent segments under extension, lateral bending, and torsion moments than the Rom-PLIF models (p=.032, p=.008, and p=.016, respectively). Furthermore, the percent increment of facet contact force was significantly higher in the Cop-PLIF models under extension and torsion moments than in the Rom-PLIF models (p=.016 under both extension and torsion moments).Conclusions
The present study showed the clinical application of subject-specific FE analysis in the spine. Even though there was biomechanical superiority of the robot-assisted insertions in terms of alleviation of stress increments at adjacent segments after fusion, cautious interpretation is needed because of the small sample size. 相似文献3.
Shujie Wang Yang Yang Jianguo Zhang Ye Tian Jianxiong Shen Shengru Wang 《The spine journal》2017,17(1):76-80
Background Context
Intraoperative monitoring (IOM) is an essential method for preventing postoperative spinal deficits during posterior vertebral column resection (VCR) surgery for treatment of severe spine deformities, but the IOM features directing at VCR procedures are rarely reported and need to be further clarified.Purpose
To evaluate an important surgical point that will lead to the IOM loss frequently, and then remind the surgeons to pay close attention to impending monitoring changes during posterior VCR surgery.Study Design/Setting
Retrospective study.Patient Sample
A total of 77 patients with severe spine deformities who underwent posterior VCR and deformity correction surgeries from January 2012 to May 2015 are retrospectively analyzed in our spine center.Outcome Measures
IOM (motor-evoked potentials [MEP] and somatosensory-evoked potentials) was used for intraoperative spinal function assessment.Methods
Patients were divided into 2 groups according to their preoperative spinal function, including 27 patients with preoperative spinal deficits and 50 patients with spinal normal. And the IOM data during surgery, especially among VCR procedures, were mainly analyzed in the present study.Results
With the VCR procedure almost complete, most patients showed varying degrees of IOM loss that included 37 cases showing obvious IOM degenerations and 21 cases showing significant IOM loss with alerts immediately. Moreover, the patients with preoperative spinal deficits have more significant decreasing percentage in MEP amplitude (81% vs. 68%, p<.05) than those patients without.Conclusions
With the VCR procedure almost complete, surgeons must pay closely attention to the IOM signals and should be ready to take corresponding surgical measures to deal with the impeding monitoring loss. 相似文献4.
Joseph E. Tanenbaum Jacob A. Miller Vincent J. Alentado Daniel Lubelski Benjamin P. Rosenbaum Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(1):62-69
Background Context
The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown.Purpose
This study determined the incidence of hospital-acquired conditions (HAC) and patient safety indicators (PSI) in patients with cervical spine fusion and analyzed the association between primary payer status and these adverse events.Study Design
This is a retrospective cohort design.Patient Sample
All patients in the Nationwide Inpatient Sample (NIS) aged 18 and older who underwent cervical spine fusion from 1998 to 2011 were included.Outcome Measures
Incidence of HAC and PSI from 1998 to 2011 served as outcome variables.Methods
We queried the NIS for all hospitalizations that included a cervical fusion during the inpatient episode from 1998 to 2011. All comparisons were made between privately insured patients and Medicaid or self-pay patients because Medicare enrollment is confounded with age. Incidence of nontraumatic HAC and PSI was determined using publicly available lists of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. We built logistic regression models to determine the effect of primary payer status on PSI and nontraumatic HAC.Results
We identified 419,424 hospitalizations with cervical fusion performed during an inpatient episode. The estimated national incidences of nontraumatic HAC and PSI were 0.35% and 1.6%, respectively. After adjusting for patient demographics and hospital characteristics, Medicaid or self-pay patients had significantly greater odds of experiencing one or more HAC (odds ratio [OR] 1.51 95% conflict of interest [CI] 1.23–1.84) or PSI (OR 1.52 95% CI 1.37–1.70) than the privately insured cohort.Conclusions
Among patients undergoing inpatient cervical fusion, primary payer status predicts PSI and HAC (both indicators of adverse health-care quality used to determine hospital reimbursement by CMS). As the US health-care system transitions to a value-based payment model, the cause of these disparities must be studied to improve the quality of care delivered to vulnerable patient populations. 相似文献5.
Hwee Weng Dennis Hey Eugene Tze-Chun Lau Joel-Louis Lim Denise Ai-Wen Choong Chuen-Seng Tan Gabriel Ka-Po Liu Hee-Kit Wong 《The spine journal》2017,17(3):360-368
Background Context
Flexion radiographs have been used to identify cases of spinal instability. However, current methods are not standardized and are not sufficiently sensitive or specific to identify instability.Purpose
This study aimed to introduce a new slump sitting method for performing lumbar spine flexion radiographs and comparison of the angular range of motions (ROMs) and displacements between the conventional method and this new method.Study Design
This study used is a prospective study on radiological evaluation of the lumbar spine flexion ROMs and displacements using dynamic radiographs.Patient Sample
Sixty patients were recruited from a single spine tertiary center.Outcome Measure
Angular and displacement measurements of lumbar spine flexion were carried out.Method
Participants were randomly allocated into two groups: those who did the new method first, followed by the conventional method versus those who did the conventional method first, followed by the new method. A comparison of the angular and displacement measurements of lumbar spine flexion between the conventional method and the new method was performed and tested for superiority and non-inferiority.Results
The measurements of global lumbar angular ROM were, on average, 17.3° larger (p<.0001) using the new slump sitting method compared with the conventional method. They were most significant at the levels of L3–L4, L4–L5, and L5–S1 (p<.0001, p<.0001 and p=.001, respectively). There was no significant difference between both methods when measuring lumbar displacements (p=.814).Conclusion
The new method of slump sitting dynamic radiograph was shown to be superior to the conventional method in measuring the angular ROM and non-inferior to the conventional method in the measurement of displacement. 相似文献6.
Amandeep Bhalla Andrew J. Schoenfeld Jaiben George Michael Moghimi Christopher M. Bono 《The spine journal》2017,17(1):143-149
Background Context
Understanding the influence of preoperative diagnosis on outcomes for lumbar fusion surgery improves the quality of research and outcomes data, and helps guide treatment decisions.Purpose
We sought to perform a systematic review of the literature published between 2000 and 2014 regarding lumbar fusion outcomes for degenerative disorders. An assessment of the influence of subgroup diagnosis on outcomes as well as the quality of this body of literature was performed.Study Design
Systematic reviewPatient Sample
The 100 studies ultimately included involved adult patients (n=8,706) undergoing fusion surgery for degenerative disorders of the lumbar spine.Outcome Measures
Visual analog scale (VAS) pain scores, complication rates, and determination of successful fusionMethods
With adherence to the PRISMA guidelines, electronic searches were performed through PubMed, Scopus, and Web of Science to identify all studies involving lumbar fusion for degenerative disc disorders from January 2000 to August 2014. Studies were eligible for inclusion if they addressed adult patients treated with lumbar fusion for one of the following: stable degenerative disc disease, unstable degenerative disc disease, degenerative disc disease not specified (DDDns), herniated disc (DH), degenerative spondylolisthesis (DDDsp), and adult degenerative scoliosis (DDDsc). Abstracted data included the number of patients, preoperative diagnosis, fusion technique, complications, fusion rate, and clinical outcomes.Results
One hundred articles met inclusion criteria and yielded data for 8,706 patients. Forty-three studies included data for clinical improvement (VAS scores). The mean clinical improvement in VAS scores was significantly different among the diagnoses (p<.001), with DDDsp demonstrating the highest improvement (60%) and DDDns having the lowest (45%). Eighty-five studies included data for complication rates. Complication rates differed significantly (p<.001), with the highest rate seen in the DDDsc group (18%), followed by DDDsp (14%). Seventy-eight studies included data for fusion. The pooled odds of fusion for prospective studies were 6.93 (95% CI 4.75, 10.13). There was no evidence of publication bias.Conclusions
A relationship between outcomes and subgroup diagnosis was demonstrated. This review demonstrated a higher quality of evidence in the literature, and greater overall fusion rates compared to similar studies published in the 1980s and 1990s. 相似文献7.
Mehmet Nuri Erdem Sinan Karaca Seckin Sarı Feridun Yumrukcal Ruhat Tanli Mehmet Aydogan 《The spine journal》2017,17(3):328-337
Background Context
The application of pedicle screws with cement to strengthen the fixation of the osteoporotic spine has increasingly gained popularity. However, the technique has also led to an increase in cement-related complications.Purpose
The aim of the present study was to compare the clinical and radiological results of the patients with degenerative spinal pathologies who were treated with pedicle screws and cement injections on all segments versus those who were treated with cement injections only on the strategic vertebrae selected.Study Design
A retrospective clinical study.Patient Sample
The sample consists of 31 patients who underwent spinal surgery due to degenerative spinal pathologies.Outcome Measures
Patients were assessed for the adequate spinal fusion and cement-related complication parameters.Methods
Thirty-one patients with a minimum follow-up period of 2 years were divided into two groups and evaluated. Group A consisted of 17 patients (14 females, 3 males; mean age: 68.1 years) with cemented pedicle screws and Group B consisted of 14 patients (12 females, 2 males; mean age: 67.2 years) with cemented screws on selected vertebrae alone. Selection of the strategic vertebrae was made by taking the most stressed regions in the fusion site into account. Prophylactic vertebroplasty was performed in all patients in Group A and on strategic segments in Group B to avoid an adjacent segment fracture. Early- and late-term complications during the follow-up period were recorded.Results
Mean follow-up period was 51.8 (range: 31 to 80) months in Group A and 41.2 (range: 26 to 61) months in Group B. Cemented pedicle screws were bilaterally placed on 94 vertebrae in Group A. In Group B, cement was applied on 28 of 80 vertebrae. Including the prophylactic vertebroplasties, a total of 111 cement applications were performed in Group A and 38 in Group B. Cement embolism, symptomatic chest discomfort, and duration of surgery were significantly higher in Group A (p<.05). No adjacent segment fracture in the proximal or distal vertebra, implant failure, or loss of correction was seen throughout the follow-up period.Conclusions
The application of cemented pedicle screws on all segments of the osteoporotic spine increases the cement volume and rate of cement-related complications. Cementing the strategic vertebrae alone will enhance the fixation strength and endurance and decrease the complications caused by cement application. 相似文献8.
Javier Z. Guzman Robert K. Merrill Jun S. Kim Samuel C. Overley James E. Dowdell Sulaiman Somani Andrew C. Hecht Samuel K. Cho Sheeraz A. Qureshi 《The spine journal》2017,17(9):1247-1254
Background Context
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been widely adopted as a fusion adjunct in spine surgery since its approval in 2002. A number of concerns regarding adverse effects and potentially devastating complications of rhBMP-2 use led to a Food and Drug Administration (FDA) advisory issued in 2008 cautioning its use, and a separate warning about its potential complications was published by The Spine Journal in 2011.Purpose
To compare trends of rhBMP-2 use in spine surgery after the FDA advisory in 2008 and The Spine Journal warning in 2011.Study Design
Retrospective cross-sectional study using a national database.Patient Sample
All patients from 2002 to 2013 who underwent spinal fusion surgery at an institution participating in the Nationwide Inpatient Sample (NIS).Outcome Measures
Proportion of spinal fusion surgeries using rhBMP-2.Methods
We queried the NIS from 2002 to 2013 and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes to identify spinal fusion procedures and those that used rhBMP-2. Procedures were subdivided into primary and revision fusions, and by region of the spine. Cervical and lumbosacral fusions were further stratified into anterior and posterior approaches. The percentage of cases using BMP was plotted across time. A linear regression was fit to the data from quarter 3 of 2008 (FDA advisory) through quarter 1 of 2011, and a separate regression was fit to the data from quarter 2 of 2011 (The Spine Journal warning) onward. The slopes of these regression lines were statistically compared to determine differences in trends. No funding was received to conduct this study, and no authors had any relevant conflicts of interest.Results
A total of 4,167,079 patients in the NIS underwent spinal fusion between 2002 and 2013. We found a greater decrease in rhBMP-2 use after The Spine Journal warning compared with the FDA advisory for all fusion procedures (p=.006), primary fusions (p=.006), and revision fusions (p=.004). Lumbosacral procedures also experienced a larger decline in rhBMP-2 use after The Spine Journal article as compared with the FDA warning (p=.0008). This pattern was observed for both anterior and posterior lumbosacral fusions (p≤.0001 for both). Anterior cervical fusion was the only procedure that demonstrated a decline in rhBMP-2 use after the FDA advisory that was statistically greater than after The Spine Journal article (p=.02).Conclusions
Warnings sanctioned through the spine literature may have a greater influence on practice of the spine surgery community as compared with advisories issued by the FDA.Comprehensive guidelines regarding safe and effective use of rhBMP-2 must be established. 相似文献9.
Parthasarathy Thirumala James Zhou Piruthiviraj Natarajan Jeffrey Balzer Edward Dixon David Okonkwo D.K. Hamilton 《The spine journal》2017,17(11):1611-1624
Background Context
Perioperative neurologic complications after spine surgery may increase morbidity and health-care costs related to the procedure.Purpose
We estimate the national incidence of perioperative neurologic complications following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion, and thoracolumbar fusion procedures using the Nationwide Inpatient Sample (NIS) data from 1999 to 2011. Additionally, we identify risk factors for developing perioperative neurologic complications and the effects of these injuries on quantifiable patient outcomes.Study Design
A cross-sectional study was carried out.Patient Sample
All patients included in the NIS databases from 1999 to 2011 comprised the sample.Outcome Measures
The primary outcome evaluated was the incidence of new neurologic deficits following elective spine surgery. Secondary outcomes evaluated include length of hospital stay, total hospital charges, hospital mortality rate, and discharge disposition.Methods
A retrospective analysis of the NIS databases from the years 1999 to 2011 was conducted to identify the proportion of patients who underwent ACDFs, posterior cervical fusions, and thoracolumbar fusions who also developed perioperative neurologic complications. Statistical analyses were also conducted to identify statistically significant differences in demographics and outcomes between patients who did and did not develop perioperative neurologic complications.Results
From 1999 to 2011, the total national incidence of perioperative neurologic deficits following elective ACDFs, posterior cervical fusions, and thoracolumbar fusions was 0.82%, which equates to a total of 15,066 patients who experienced these complications. The annual incidence rate of perioperative neurologic deficits has increased 54.41%, from 0.68% in the year 1999 to 1.05% in the year 2011. Additionally, the total number of procedures performed increased from 82,167 in 1999 to 186,353 in the year 2011. Perioperative neurologic deficits were associated with longer lengths of stay (9.68 days vs. 2.59 days; p<.001), higher total charges ($110,326.23 vs. $48,695.93; p<.001), and higher in-hospital mortality (2.84% vs. 0.13%; p<.001).Conclusions
The incidence rate of perioperative neurologic deficits associated with elective spine surgery documented in the NIS has increased over the time period from 1999 to 2011. The number of elective spine procedures performed has also increased over the same time period. Finally, outcomes data indicate that occurrence of perioperative neurologic complications is associated with increased rates of morbidity and mortality, as well as increased health-care use and cost. These trends indicate that the perioperative neurologic complications following spine surgery represent a growing problem in today's health-care system; further study is warranted to prevent and treat these complications to improve patient care and reduce health-care use and cost. 相似文献10.
Michael K. Urban Kara Fields Sean W. Donegan Jonathan C. Beathe David W. Pinter Oheneba Boachie-Adjei Ronald G. Emerson 《The spine journal》2017,17(12):1889-1896
Background Context
Lidocaine has emerged as a useful adjuvant anesthetic agent for cases requiring intraoperative monitoring of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). A previous retrospective study suggested that lidocaine could be used as a component of propofol-based intravenous anesthesia without adversely affecting MEP or SSEP monitoring, but did not address the effect of the addition of lidocaine on the MEP and SSEP signals of individual patients.Purpose
The purpose of this study was to examine the intrapatient effects of the addition of lidocaine to balanced anesthesia on MEPs and SSEPs during multilevel posterior spinal fusion.Study Design
This is a prospective, two-treatment, two-period crossover randomized controlled trial with a blinded primary outcome assessment.Patient Sample
Forty patients undergoing multilevel posterior spinal fusion were studied.Outcome Measures
The primary outcome measures were MEP voltage thresholds and SSEP amplitudes. Secondary outcome measures included isoflurane concentrations and hemodynamic parameters.Methods
Each participant received two anesthetic treatments (propofol 50?mcg/kg/h and propofol 25?mcg/kg/h+lidocaine 1?mg/kg/h) along with isoflurane, ketamine, and diazepam. In this manner, each patient served as his or her own control. The order of administration of the two treatments was determined randomly.Results
There were no significant within-patient differences between MEP threshold voltages or SSEP amplitudes during the two anesthetic treatments.Conclusions
Lidocaine may be used as a component of balanced anesthesia during multilevel spinal fusions without adversely affecting the monitoring of SSEPs or MEPs in individual patients. 相似文献11.
Ronald H.M.A. Bartels Roland D. Donk Wim I.M. Verhagen Allard J.F. Hosman André L.M. Verbeek 《The spine journal》2017,17(11):1625-1632
Background Context
The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance.Purpose
This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis.Study Design
This study is a review of the literature.Patient Sample
This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty.Outcome Measure
The outcome measure used in the study was the MCID.Methods
We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature.Results
We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance.Conclusions
The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement. 相似文献12.
Bret H. Clough Eoin P. McNeill Daniel Palmer Ulf Krause Thomas J. Bartosh Christopher D. Chaput Carl A. Gregory 《The spine journal》2017,17(3):418-430
Background Context
Spine pain and the disability associated with it are epidemic in the United States. According to the National Center for Health Statistics, more than 650,000 spinal fusion surgeries are performed annually in the United States, and yet there is a failure rate of 15%–40% when standard methods employing current commercial bone substitutes are used. Autologous bone graft is the gold standard in terms of fusion success, but the morbidity associated with the procedure and the limitations in the availability of sufficient material have limited its use in the majority of cases. A freely available and immunologically compatible bone mimetic with the properties of live tissue is likely to substantially improve the outcome of spine fusion procedures without the disadvantages of autologous bone graft.Purpose
This study aimed to compare a live human bone tissue analog with autologous bone grafting in an immunocompromised rat model of posterolateral fusion.Design/Setting
This is an in vitro and in vivo preclinical study of a novel human stem cell–derived construct for efficacy in posterolateral lumbar spine fusion.Methods
Osteogenically enhanced human mesenchymal stem cells (OEhMSCs) were generated by exposure to conditions that activate the early stages of osteogenesis. Immunologic characteristics of OEhMSCs were evaluated in vitro. The secreted extracellular matrix from OEhMSCs was deposited on a clinical-grade gelatin sponge, resulting in bioconditioned gelatin sponge (BGS). Bioconditioned gelatin sponge was used alone, with live OEhMSCs (BGS+OEhMSCs), or with whole human bone marrow (BGS+hBM). Efficacy for spine fusion was determined by an institutionally approved animal model using 53 nude rats.Results
Bioconditioned gelatin sponge with live OEhMSCs did not cause cytotoxicity when incubated with immunologically mismatched lymphocytes, and OEhMSCs inhibited lymphocyte expansion in mixed lymphocyte assays. Bioconditioned gelatin sponge with live OEhMSC and BGS+hBM constructs induced profound bone growth at fusion sites in vivo, with a comparable rate of fusion with syngeneic bone graft (negative [0 of 10], BGS alone [0 of 10], bone graft [7 of 10], BGS+OEhMSC [10 of 15], and BGS+hBM [8 of 8]).Conclusions
Collectively, these studies demonstrate that BGS+OEhMSC constructs possess low immunogenicity and drive vertebral fusion with efficiency matching syngeneic bone graft in rodents. We also demonstrate that BGS serves as a promising scaffold for spine fusion when combined with hBM. 相似文献13.
Xiaofei Cheng Kai Zhang Xiaojiang Sun Changqing Zhao Hua Li Bin Ni Jie Zhao 《The spine journal》2017,17(8):1127-1133
Background Context
Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures.Purpose
This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis.Study Design
This is a prospective cohort study.Patient Sample
This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF.Outcome Measures
Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score.Methods
The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168).Results
There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group.Conclusions
When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery. 相似文献14.
Daniel D. Bohl Fady Y. Hijji Dustin H. Massel Benjamin C. Mayo William W. Long Krishna D. Modi Ankur S. Narain Blaine T. Manning Junyoung Ahn Philip K. Louie Kern Singh 《The spine journal》2017,17(3):305-312
Background Context
Spine surgeons employ a high volume of imaging in the diagnosis and evaluation of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques.Purpose
To characterize spine patients' knowledge regarding radiation exposure from various imaging modalities.Study Design/Setting
A cross-sectional survey study.Patient Sample
One hundred patients at their first clinic visit with a single spine surgeon at an urban institution.Outcome Measures
The primary outcome was patient estimate of radiation dose for various common spinal imaging modalities as compared with true dose.Methods
An electronic survey was administered to all new patients before their first appointment with a single spinal surgeon. The survey asked patients to estimate how many chest x-rays (CXRs) worth of radiation were equivalent to various common spinal imaging modalities. Patient estimates were compared to true effective radiation doses determined from the literature. The survey also asked patients whether they would consider avoiding types of imaging modalities out of concern for excessive radiation exposure.Results
Patients accurately approximated the radiation associated with two views of the cervical spine, with a median estimate of 3.5 CXRs, compared with an actual value of 4.7 CXRs. However, patients underestimated the dose for computed tomography (CT) scans of the cervical spine (2.0 CXRs vs. 145.3 CXRs), two views of the lumbar spine (3.0 CXRs vs. 123.3 CXRs), and CT scans of the lumbar spine (2.0 CXRs vs. 638.3 CXRs). The majority of patients believed that there is at least some radiation exposure associated with magnetic resonance imaging (MRI). The percent of patients who would consider forgoing imaging recommend by their surgeon out of concern for radiation exposure was 14% for x-rays, 13% for CT scans, and 9% for MRI.Conclusion
These results demonstrate a lack of patient understanding regarding radiation exposure associated with common spinal imaging techniques. These data suggest that patients might benefit from increased counseling and/or educational materials regarding radiation exposure before undergoing diagnostic imaging of the cervical or lumbar spine. 相似文献15.
Shujie Wang Jianguo Zhang Ye Tian Jianxiong Shen Yu Zhao Hong Zhao Shugang Li Bin Yu Xisheng Weng 《The spine journal》2017,17(6):777-783
Background Context
Transcranial motor evoked potential (MEP) monitoring has been widely adopted in spine surgery, but so far the useful monitoring data for patients with preoperative spinal deficits (PPSDs) are limited. Originally we thought that they seemed technically more difficult and less reliable in performing the MEP monitoring to PPSDs.Purpose
Our objective was to study (1) the feasibility of MEP monitoring in PPSDs and the (2) the significance of rapid MEP loss.Study Design/Setting
A retrospective case notes study from a prospective patient register was used as the study design.Patient Sample
A total of 332 PPSDs who underwent posterior spine surgery with a reliable MEP monitoring were collected between September 2010 and December 2014.Outcome Measures
Relevant MEP loss was identified as rapid amplitude reduction (more than 80% MEP) associated with high-risk surgical maneuvers or high-risk diagnoses.Method
The muscles with higher strength were used to record the optimal MEP signal. MEP monitoring of these patients was considered to be feasible if reproducible signals had been obtained; moreover, sensitivity, specificity, positive predictive value (PPV), and negative predictive value were computed. The significance of the patients with rapid MEP loss was analyzed.Results
From a total of 332 PPSDs, 27 cases showed significant MEP loss (23 true positive, 4 false positive), and 21 showed new spinal deficits. Invalid MEP baselines were found in 11 paralysis and 6 severely incomplete paraplegia patients, and success rate of reliable MEP was 95.1% in PPSDs. The congenital kyphoscoliosis, tuberculous kyphoscoliosis, and thoracic spinal stenosis are considered high-risk diagnoses to result in MEP loss. The sensitivity of intraoperative MEP monitoring was 100%, the specificity 98.7%, the positive predictive value 85.2%, and the negative predictive value 100%.Conclusions
Intraoperative MEP monitoring is feasible for most of the PPSDs. The rapid MEP loss during high-risk diagnoses and complicated surgical procedures may indicate new spinal deficits. 相似文献16.
Matthew J. McGirt Scott L. Parker Praveen Mummaneni John Knightly Deborah Pfortmiller Kevin Foley Anthony L. Asher 《The spine journal》2017,17(7):922-932
Background Context
Over the last decade, clinical investigators and biomedical industry groups have used significant resources to develop advanced technologies that enable less invasive spine fusions. These minimally invasive surgery (MIS) technologies often require increased expenditures by hospitals and payers. Although several small single center studies have suggested MIS technologies decrease surgical morbidity and reduce hospital stay, evidence documenting benefit from a patient perspective remains limited. Furthermore, MIS outcomes have yet to be evaluated from the perspective of multiple practice types representing the broad spectrum of US spine surgery.Purpose
This study aimed to examine a population of patients who underwent one- or two-level interbody lumbar fusion diagnosed with lumbar stenosis or Grade 1 spondylolisthesis in an observational, prospective national registry for the purposes of determining how MIS and traditional open technologies affect postsurgical and patient-reported outcomes (PROs).Study Design/Setting
This study used observational analysis of prospectively collected data.Patient Sample
The sample consisted of cases from the National Neurosurgery Quality and Outcomes Database (N2QOD).Outcome Measures
Numeric rating scale for back and leg pain, Oswestry Disability Index, EuroQol-5D, return to work, and perioperative morbidity were the outcome measures.Methods
The N2QOD is a prospective PROs registry enrolling patients undergoing elective spine surgery from 60 hospitals in 27 US states via representative sampling. We analyzed the N2QOD aggregate dataset (2010–2014) to identify one- and two-level lumbar interbody fusion procedures performed for lumbar stenosis or Grade 1 spondylolisthesis with 12 months' follow-up where surgical instrumentation and implant types were clearly identified. Perioperative and 1-year outcomes were compared between cases performed with MIS enabling technologies versus traditional open technologies before and after propensity matching.Results
There were 467 (24%) patients who underwent elective interbody lumbar fusion using MIS enabling technologies whereas 1,480 (76%) underwent the procedure using traditional open technologies. The MIS patients were slightly healthier (American Society of Anesthesiologists grade), had private insurance more frequently, and underwent two-level fusion less frequently. Unmatched, the MIS cohort was associated with reduced blood loss, a 0.7-day reduction in mean length of hospital stay, and 5% reduced need for post-discharge inpatient rehabilitation, but equivalent 90-day safety measures. After propensity matching, the MIS cohort remained associated with reduced blood loss and a shorter length of stay for one-level fusion (p<.05) but had equivalent length of stay for two-level fusion. Outcomes in all other 90-day safety measures were similar. In both unadjusted and propensity-matched comparison, MIS versus open technologies were associated with equivalent return to work, patient-reported pain, physical disability, and quality of life at 3 and 12 months' follow-up.Conclusions
In a representative sampling registry of elective interbody lumbar spine fusion procedures spanning 27 US states, nearly a quarter of procedures performed from 2010 to 2014 used minimally invasive enabling technologies. Regardless of approach, interbody lumbar fusion was associated with significant and sustained improvements in all measured health domains. When used in everyday care by a wide spectrum of spine surgeons in non-research settings, the use of MIS technologies was associated with reduced intraoperative blood loss but only a half-day reduction in mean length of hospital stay for one-level fusions. Minimally invasive surgery was not associated with any improved perioperative safety measures or 12-month outcomes. Although MIS enabling technologies may increase some in-hospital care efficiencies, MIS clinical outcomes are similar to open surgery for patients undergoing one- and two-level interbody lumbar fusions. 相似文献17.
Vincent J. Alentado Stephanie Caldwell Heath P. Gould Michael P. Steinmetz Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(2):236-243
Background Context
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.Purpose
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study Design
This is a retrospective review of patients who underwent instrumented lumbar fusion.Patient Sample
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome Measures
Outcome measures included preoperative and postoperative EQ-5D Index scores.Materials and Methods
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.Results
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.Conclusions
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively. 相似文献18.
Fon-Yih Tsuang Chia-Hsien Chen Yi-Jie Kuo Wei-Lung Tseng Yuan-Shen Chen Chin-Jung Lin Chun-Jen Liao Feng-Huei Lin Chang-Jung Chiang 《The spine journal》2017,17(9):1373-1380
Background Context
Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions.Purpose
This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy.Study Design
A technical report (a retrospective and prospective case series) was carried out.Patient Sample
Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample.Method
We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions.Results
In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2–14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2–16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9–T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary.Conclusion
This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy. 相似文献19.
Joseph E. Tanenbaum Vincent J. Alentado Jacob A. Miller Daniel Lubelski Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(3):338-345
Background Context
Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) used by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients.Purpose
This study sought to determine the incidence of PSI in patients undergoing inpatient lumbar fusion and to quantify the association between primary payer status and PSI in this population.Study Design
A retrospective cohort study was carried out.Patient Sample
The sample comprised all adult patients aged 18 years and older who were included in the Nationwide Inpatient Sample (NIS) that underwent lumbar fusion from 1998 to 2011.Outcome Measure
The incidence of one or more PSI, a validated and widely used metric of inpatient health-care quality and patient safety, was the primary outcome variable.Methods
The NIS data were examined for all cases of inpatient lumbar fusion from 1998 to 2011. The incidence of adverse patient safety events (PSI) was determined using publicly available lists of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Logistic regression models were used to determine the association between primary payer status (Medicaid and self-pay relative to private insurance) and the incidence of PSI.Results
A total of 539,172 adult lumbar fusion procedures were recorded in the NIS from 1998 to 2011. Patients were excluded from the secondary analysis if “other” or “missing” was listed for primary insurance status. The national incidence of PSI was calculated to be 2,445 per 100,000 patient years of observation, or approximately 2.5%. In a secondary analysis, after adjusting for patient demographics and hospital characteristics, Medicaid and self-pay patients had significantly greater odds of experiencing one or more PSI during the inpatient episode relative to privately insured patients (odds ratio 1.16, 95% confidence interval 1.07–1.27).Conclusions
Among patients undergoing inpatient lumbar fusion, insurance status is associated with the adverse health-care quality events used to determine hospital reimbursement by the CMS. The source of this disparity must be studied to improve the quality of care delivered to vulnerable patient populations. 相似文献20.
Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality
M. Martín-Fernández A. López-Herradón A.R. Piñera F. Tomé-Bermejo J.M. Duart M.D. Vlad M.G. Rodríguez-Arguisjuela L. Alvarez-Galovich 《The spine journal》2017,17(8):1192-1199