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Mastrokostas PG, Mastrokostas LE, Emara AK, Wellington IJ, Ginalis E, Houten JK, Khalsa AS, Saleh A, Razi AE, Ng MK. Modern Internet Search Analytics: Is There a Difference in What Patients are Searching Regarding the Operative and Nonoperative Management of Scoliosis? Global Spine J 2024:21925682241248110. [PMID: 38613478 DOI: 10.1177/21925682241248110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Observational Study. OBJECTIVES This study aimed to investigate the most searched types of questions and online resources implicated in the operative and nonoperative management of scoliosis. METHODS Six terms related to operative and nonoperative scoliosis treatment were searched on Google's People Also Ask section on October 12, 2023. The Rothwell classification was used to sort questions into fact, policy, or value categories, and associated websites were classified by type. Fischer's exact tests compared question type and websites encountered between operative and nonoperative questions. Statistical significance was set at the .05 level. RESULTS The most common questions concerning operative and nonoperative management were fact (53.4%) and value (35.5%) questions, respectively. The most common subcategory pertaining to operative and nonoperative questions were specific activities/restrictions (21.7%) and evaluation of treatment (33.3%), respectively. Questions on indications/management (13.2% vs 31.2%, P < .001) and evaluation of treatment (10.1% vs 33.3%, P < .001) were associated with nonoperative scoliosis management. Medical practice websites were the most common website to which questions concerning operative (31.9%) and nonoperative (51.4%) management were directed to. Operative questions were more likely to be directed to academic websites (21.7% vs 10.0%, P = .037) and less likely to be directed to medical practice websites (31.9% vs 51.4%, P = .007) than nonoperative questions. CONCLUSIONS During scoliosis consultations, spine surgeons should emphasize the postoperative recovery process and efficacy of conservative treatment modalities for the operative and nonoperative management of scoliosis, respectively. Future research should assess the impact of website encounters on patients' decision-making.
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Affiliation(s)
- Paul G Mastrokostas
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | | | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ian J Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Hartford, CT, USA
| | | | - John K Houten
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Amrit S Khalsa
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Saleh
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
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Koch KM, Nencka AS, Kurpad S, Budde MD. Diffusion Weighted Magnetic Resonance Imaging of Spinal Cord Injuries After Instrumented Fusion Stabilization. J Neurotrauma 2024. [PMID: 38251658 DOI: 10.1089/neu.2023.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is a promising technique for assessing spinal cord injury (SCI) that has historically been challenged by the presence of metallic stabilization hardware. This study leverages recent advances in metal-artifact resistant multi-spectral DW-MRI to enable diffusion quantification throughout the spinal cord even after fusion stabilization. Twelve participants with cervical spinal cord injuries treated with fusion stabilization and 49 asymptomatic able-bodied control participants underwent multi-spectral DW-MRI evaluation. Apparent diffusion coefficient (ADC) values were calculated in axial cord sections. Statistical modeling assessed ADC differences across cohorts and within distinct cord regions of the SCI participants (at, above, or below injured level). Computed models accounted for subject demographics and injury characteristics. ADC was found to be elevated at injured levels compared with non-injured levels (z = 3.2, p = 0.001), with ADC at injured levels decreasing over time since injury (z = -9.2, p < 0.001). Below the injury level, ADC was reduced relative to controls (z = -4.4, p < 0.001), with greater reductions after more severe injuries that correlated with lower extremity motor scores (z = 2.56, p = 0.012). No statistically significant differences in ADC above the level of injury were identified. By enabling diffusion analysis near fusion hardware, the multi-spectral DW-MRI technique allowed intuitive quantification of cord diffusion changes after SCI both at and away from injured levels. This demonstrates the approach's potential for assessing post-surgical spinal cord integrity throughout stabilized regions.
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Affiliation(s)
- Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shekar Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Annapureddy D, Venkatesh P, Azam F, Olivier T, Thakur B, Sloan E, Wingfield S, Bagley C, Lopez M. Predictors of Admission to Post-Acute Rehabilitation Following Multi-Level Spinal Decompression and Fusion Surgery and its Associated Outcomes. World Neurosurg 2024:S1878-8750(24)00572-2. [PMID: 38599376 DOI: 10.1016/j.wneu.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To investigate predictive factors and outcomes in those admitted to post-acute rehabilitation (PAR) versus those that discharged home following multi-level spinal decompression and fusion surgery. DESIGN Retrospective case review study of adults that underwent multi-level spinal decompression and fusion surgery between 2016 to 2022 at an academic institution. Pre-operative, peri-operative, post-operative, and outcomes variables were compared between those discharged home versus PAR. Finally, multiple logistic regression was used to determine factors contributing to PAR admission. RESULTS Of 241 total patients, 89 (37%) discharged home and 152 (63%) discharged to PAR. Among home discharge patients, 45.9% used an assistive device, while among PAR patients, 61.5% used one (p=0.041). Mean pre-operative Oswestry Disability Index score was significantly lower in the home discharge group compared to the PAR discharge group (40.3 vs. 45.3 respectively, p=0.044). Females were 2.43 times more likely to be discharged to PAR compared to males (95% CI: 1.06, 5.54, p=0.04). Patients with a mood disorder had 2.81 times higher odds of being discharged to PAR compared to those without (95% CI: 1.20, 6.60, p=0.02). Other variables evaluated were not statistically significant. CONCLUSIONS Female sex and presence of a mood disorder increase the likelihood to PAR discharge following multi-level spinal decompression surgery.
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Affiliation(s)
| | - Pooja Venkatesh
- The University of Texas Southwestern Medical School, Dallas, TX.
| | - Faraaz Azam
- The University of Texas Southwestern Medical School, Dallas, TX
| | - Timothy Olivier
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Bhaskar Thakur
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Ellen Sloan
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Sarah Wingfield
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, MO, USA
| | - Marielisa Lopez
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX
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4
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Cottrill E, Pennington Z, Sattah N, Jing C, Salven D, Johnson E, Downey M, Varghese S, Rocos B, Richardson W. Gene Therapy and Spinal Fusion: Systematic Review and Meta-analysis of the Available Data. World Neurosurg 2024:S1878-8750(24)00560-6. [PMID: 38583566 DOI: 10.1016/j.wneu.2024.03.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To analyze the extant literature describing the application of gene therapy to spinal fusion. METHODS A systematic review of the English-language literature was performed. The search query was designed to include all published studies examining gene therapy approaches to promote spinal fusion. Approaches were classified as ex vivo (delivery of genetically modified cells) or in vivo (delivery of growth factors via vectors). The primary endpoint was fusion rate. Random effects meta-analyses were performed to calculate the overall odds ratio (OR) of fusion using a gene therapy approach and overall fusion rate. Sub-group analyses of fusion rate were also performed for each gene therapy approach. RESULTS Of 1179 results, 35 articles met criteria for inclusion (all preclinical), of which 26 utilized ex vivo approaches and 9 utilized in vivo approaches. Twenty-seven articles (431 animals) were included in the meta-analysis. Gene therapy use was associated with significantly higher fusion rates (OR 77; 95% CI: [31, 192]; p<0.001); ex vivo strategies had a greater effect (OR 136) relative to in vivo strategies (OR 18) (p=0.017). The overall fusion rate using a gene therapy approach was 80% (95% CI: [62%, 93%]; p<0.001); overall fusion rates were significantly higher in subjects treated with ex vivo compared to in vivo strategies (90% vs 42%; p=0.011). For both ex vivo and in vivo approaches, the effect of gene therapy on fusion was independent of animal model. CONCLUSIONS Gene therapy may augment spinal fusion; however, future investigation in clinical populations is necessary.
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Affiliation(s)
- Ethan Cottrill
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA.
| | - Zach Pennington
- Department of Neurosurgery, Duke University Health System, Durham, NC, USA
| | - Nathan Sattah
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
| | - Crystal Jing
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
| | - Dave Salven
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
| | - Eli Johnson
- Department of Neurosurgery, Duke University Health System, Durham, NC, USA
| | - Max Downey
- Department of Surgery, NYU Grossman School of Medicine, NY, USA
| | - Shyni Varghese
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brett Rocos
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
| | - William Richardson
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
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Araujo Ono AHD, Pereira Filho ARD, Araujo FFD, Marcon RM, Cristante AF, Barros Filho TEDP. Access to the Lumbosacral Spine: A Current View. Rev Bras Ortop 2024; 59:e153-e159. [PMID: 38606134 PMCID: PMC11006527 DOI: 10.1055/s-0044-1785462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/04/2023] [Indexed: 04/13/2024] Open
Abstract
The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.
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Affiliation(s)
- Allan Hiroshi de Araujo Ono
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | - Fernando Flores de Araujo
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Raphael Marthus Marcon
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Alexandre Fogaça Cristante
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
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Adapa AR, Linzey JR, Moriguchi F, Daou BJ, Khalsa SSS, Ponnaluri-Wears S, Thompson BG, Park P, Pandey AS. Risk factors and morbidity associated with surgical site infection subtypes following adult neurosurgical procedures. Br J Neurosurg 2024; 38:503-509. [PMID: 33779461 DOI: 10.1080/02688697.2021.1905773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype. METHODS A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis. RESULTS 9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, p < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, p = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, p = 0.022). CONCLUSION Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
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Affiliation(s)
- Arjun R Adapa
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Badih J Daou
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Paul Park
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
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Nishida K, Park H, Ogiri M, Rossi A. Clinical and Economic Outcomes of Patients with Osteoporosis Undergoing Spine Fusion Surgery in Japan. Spine Surg Relat Res 2024; 8:163-170. [PMID: 38618219 PMCID: PMC11007240 DOI: 10.22603/ssrr.2023-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/02/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Spinal fusion surgery with instrumentation is a treatment of choice for many spinal disorders; however, there is little data related to factors associated with early and late outcomes, especially among patients with poor bone quality (e.g., osteoporosis). We conducted this study to characterize the epidemiology and outcomes of patients undergoing spinal fusion surgery with instrumentation in Japan, especially in patients with poor bone quality and those needing additional fixation methods. Methods This retrospective observational study used real-world health insurance claims data from the Japanese Medical Data Vision. Adult patients undergoing an index spinal fusion procedure from April 1, 2010, to September 30, 2017, with procedural details, length of stay (LOS), total in-hospital costs, spine-related reoperation, all-cause readmission, and postoperative complications recorded. Data were summarized descriptively overall, by osteoporosis status, and additional fixation method used, and were analyzed in bivariate analyses. Multivariate logistic and linear regressions were used to explore associations between covariates and variables of interest. Results A total of 22,932 patients (mean age, 67.3 years; 51.2% male) met the study criteria and were included. A total of 5,288 (23.0%) patients had osteoporosis, and 2,507 (10.9%) needed additional fixation methods; these patients were older, more frequently female, and had higher Elixhauser comorbidity index scores. Osteoporosis and additional fixation use were also associated with longer LOS, higher hospital costs, and higher rates of complications. Conclusions Patients with osteoporosis and those needing additional fixation methods have a higher risk for procedural and postoperative complications, reoperation, longer LOS, and higher total hospital costs.
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Affiliation(s)
- Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - HyeJin Park
- Health Economics and Market Access, Johnson & Johnson Medical, Seoul, Republic of Korea
| | - Mami Ogiri
- Health Economics and Market Access, Johnson & Johnson Medical J.J.K.K., Tokyo, Japan
| | - Anne Rossi
- Health Economics and Market Access, Johnson & Johnson Medical, Socresby, Australia
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Scariano G, Meade S, Sultan A, Shost M, Benzel EC, Krishnaney A, Mroz T, Steinmetz MP, Habboub G. Exploring tribology and material contact science in spine surgery: implications for implant design. J Neurosurg Spine 2024:1-10. [PMID: 38518282 DOI: 10.3171/2024.1.spine231047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 03/24/2024]
Abstract
Tribology, an interdisciplinary field concerned with the science of interactions between surfaces in contact and their relative motion, plays a well-established role in the design of orthopedic implants, such as knee and hip replacements. However, its applications in spine surgery have received comparatively less attention in the literature. Understanding tribology is pivotal in elucidating the intricate interactions between metal, polymer, and ceramic components, as well as their interplay with the native human bone. Numerous studies have demonstrated that optimizing tribological factors is key to enhancing the longevity of joints and implants while simultaneously reducing complications and the need for revision surgeries in both arthroplasty and spinal fusion procedures. With an ever-growing and diverse array of spinal implant devices hitting the market for static and dynamic stabilization of the spine, it is important to consider how each of these devices optimizes these parameters and what factors may be inadequately addressed by currently available technology and methods. In this comprehensive review, the authors' objectives were twofold: 1) delineate the unique challenges encountered in spine surgery that could be addressed through optimization of tribological parameters; and 2) summarize current innovations and products within spine surgery that look to optimize tribological parameters and highlight new avenues for implant design and research.
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Affiliation(s)
- Gabrielle Scariano
- 1Case Western Reserve University School of Medicine, Cleveland
- Departments of2Orthopaedic Surgery and
| | - Seth Meade
- 3Neurosurgery, and
- 4Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Assem Sultan
- Departments of2Orthopaedic Surgery and
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Michael Shost
- 1Case Western Reserve University School of Medicine, Cleveland
- 3Neurosurgery, and
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Edward C Benzel
- 3Neurosurgery, and
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Ajit Krishnaney
- 3Neurosurgery, and
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Thomas Mroz
- Departments of2Orthopaedic Surgery and
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Michael P Steinmetz
- 3Neurosurgery, and
- 4Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
| | - Ghaith Habboub
- 3Neurosurgery, and
- 4Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- 5Center for Spine Health, Cleveland Clinic Foundation, Cleveland; and
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9
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Bae Y, Yon DK, Lee SW. Cerebrovascular Complications in Spinal Fusion Surgery: A Nationwide 8-year Follow-up Study in South Korea. Clin Nurs Res 2024:10547738241240801. [PMID: 38511266 DOI: 10.1177/10547738241240801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This retrospective study investigated the long-term incidence and risk of postoperative complications following spinal fusion. This study included 640,366 participants from a National Health Examination cohort in the Republic of Korea. Among them, 11,699 individuals underwent spinal fusion, and 56,667 individuals who underwent non-fusion spinal procedures served as controls. Propensity score matching was used to account for patient characteristics including demographic factors, comorbidities, and other relevant variables. The participants were followed for 8 years to assess the occurrence of cerebrovascular disease (CVD), hemorrhagic infarction (HA), ischemic infarction (II), occlusion and stenosis, and ischemic heart disease (IHD). The incidence rates of CVD and IHD were found to be 27.58 and 31.45 per 1,000 person-years in the spinal fusion group compared to 18.68 and 25.73 per 1,000 person-years in the control group (p < .001), respectively. Patients who underwent spinal fusion had a higher risk of CVD, HA, and IHD than those in the control group (all p < .001). In the subgroup analysis, thoracolumbar and noncervical spinal fusion were associated with a higher risk of CVD, II, and IHD (all p < .005). Patients undergoing thoracolumbar fusion may have an increased association with CVD, II in cerebral arteries, and IHD. This suggests a need for careful consideration of vascular risks in such patient populations.
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Affiliation(s)
- Youngoh Bae
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
- Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Dong Keon Yon
- Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
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Mueller KB, Hou Y, Beach K, Griffin LP. Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery. J Spine Surg 2024; 10:40-54. [PMID: 38567014 PMCID: PMC10982919 DOI: 10.21037/jss-23-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/21/2023] [Indexed: 04/04/2024]
Abstract
Background Surgical site complications (SSCs) contribute to increased healthcare costs. Predictive analytics can aid in identifying high-risk patients and implementing optimization strategies. This study aimed to develop and validate a risk-assessment score for SSC-associated readmissions (SSC-ARs) in patients undergoing open spine surgery. Methods The Premier Healthcare Database (PHD) of adult patients (n=157,664; 3,182 SSC-ARs) between January 2019 and September 2020 was used for retrospective data analysis to create an SSC risk score using mixed effects logistic regression modeling. Full and reduced models were developed using patient-, facility-, or procedure-related predictors. The full model used 37 predictors and the reduced used 19. Results The reduced model exhibited fair discriminatory capability (C-statistic =74.12%) and demonstrated better model fit [Pearson chi-square/degrees of freedom (DF) =0.93] compared to the full model (C-statistic =74.56%; Pearson chi-square/DF =0.92). The risk scoring system, based on the reduced model, comprised the following factors: female (1 point), blood disorder [2], congestive heart failure [2], dementia [3], chronic pulmonary disease [2], rheumatic disease [3], hypertension [2], obesity [2], severe comorbidity [2], nicotine dependence [1], liver disease [2], paraplegia and hemiplegia [3], peripheral vascular disease [2], renal disease [2], cancer [1], diabetes [2], revision surgery [2], operative hours ≥5 [4], emergency/urgent surgery [2]. A final risk score (sum of the points for each surgery; range, 0-40) was validated using a 1,000-surgery random hold-out sample (C-statistic =85.16%). Conclusions The resulting SSC-AR risk score, composed of readily obtainable clinical information, could serve as a robust predictive tool for unplanned readmissions related to wound complications in the preoperative setting of open spine surgery.
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Affiliation(s)
- Kyle B. Mueller
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Ruggiero N, Soliman MAR, Kuo CC, Aguirre AO, Quiceno E, Saleh J, Yeung K, Khan A, Hess RM, Lim J, Smolar DE, Pollina J, Mullin JP. The Effect of Diabetes on Complications After Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00383-8. [PMID: 38460815 DOI: 10.1016/j.wneu.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Spinal fusion procedures are used to treat a wide variety of spinal pathologies. Diabetes mellitus (DM) has been shown to be a significant risk factor for several complications following these procedures in previous studies. To the authors' knowledge, this is the first systematic review and meta-analysis elucidating the relationship between DM and complications occurring after spinal fusion procedures. METHODS Systematic literature searches of PubMed and EMBASE were performed from their inception to October 1, 2022, to identify studies that directly compared postfusion complications in patients with and without DM. Studies met the prespecified inclusion criteria if they reported the following data for patients with and without DM: (1) demographics; (2) postspinal fusion complication rates; and (3) postoperative clinical outcomes. The included studies were then pooled and analyzed. RESULTS Twenty-eight studies, with a cumulative total of 18,853 patients (2,695 diabetic patients), were identified that met the inclusion criteria. Analysis showed that diabetic patients had significantly higher rates of total number of postoperative complications (odds ratio[OR]=1.33;95% confidence interval[CI]=1.12-1.58;p=.001), postoperative pulmonary complications (OR=2.01;95%CI=1.31-3.08;p=.001), postoperative renal complications (OR=2.20;95%CI=1.27-3.80;p=.005), surgical site infection (OR=2.65;95%CI=2.19-3.20;p<.001), and prolonged hospital stay (OR=1.67; 95%CI=1.47-1.90; p<.001). CONCLUSIONS Patients with DM had a significantly higher risk of developing complications after spinal fusion, particularly pulmonary and renal complications, in addition to surgical site infections and had a longer length of stay. These findings are important for informed discussions of surgical risks with patients and families before surgery.
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Affiliation(s)
- Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Julian Saleh
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | | | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - David E Smolar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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12
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El Yaagoubi Y, Lioret E, Thomas C, Loret JE, Simonneau A, Michaud-Robert AV, Philippe L, Ogielska M, Prunier-Aesch C. Value of 18 F-FDG PET/CT to Identify Occult Infection in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Intraoperative Cultures. World J Nucl Med 2024; 23:17-24. [PMID: 38595836 PMCID: PMC11001461 DOI: 10.1055/s-0044-1778711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective Fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) has gained attention as an emerging tool in case of suspicion of infection on spine, whether native or instrumented. However, the diagnostic performance of 18 F-FDG PET/CT in clinically occult low-grade surgical site infection (SSI) after spinal fusion, an important risk factor for pseudarthrosis, remains unknown. Methods We retrospectively identified all the presumed aseptic patients with pseudarthrosis confirmed by revision surgery who underwent preoperative 18 F-FDG PET/CT scans performed between April 2019 and November 2022. These patients were presumed aseptic because they did not have clinical signs or laboratory tests suggestive of SSI, preoperatively. The PET/CT images were analyzed in consensus by two nuclear medicine physicians blinded to the clinical, biological, and imaging information. Visual assessment of increased uptake around cage/intervertebral disk space (and/or hardware) higher than background recorded from the first normal adjacent vertebra was interpreted as positive. Image data were also quantitatively analyzed by the maximum standardized uptake value as an index of 18 F-FDG uptake, and the ratio between the uptake around cage/intervertebral disk space (and/or hardware) and background recorded from the first normal adjacent vertebra was calculated. The final diagnosis of infection was based on intraoperative cultures obtained during pseudarthrosis revision surgery. Results Thirty-six presumed aseptic patients with surgically confirmed pseudarthrosis after spinal fusion underwent preoperative 18 F-FDG PET/CT scans. Cultures of samples from revisions found that 20 patients (56%) were infected. The most frequent isolated bacterium was Cutibacterium acnes ( C. acnes ) in 15 patients (75%), followed by coagulase-negative staphylococci (CNS) in 7 patients (33%). Two patients had co-infections involving both C. acnes and CNS. Of the 36 PET/CT studied in this study, 12 scans were true-negative, 10 true-positive, 10 false-negative, and 4 false-positive. This resulted in sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 50%, 75%, 71%, 55%, and 61%, respectively. Conclusion In presumed aseptic pseudarthrosis after spinal fusion, 18 F-FDG PET/CT offers good specificity (75%) but low sensitivity (50%) to identify occult SSI. The high prevalence (56%) of SSI, mostly caused by C. acnes (75%), found in our presumed aseptic cohort of patients supports the utility of systematic intraoperative cultures in revision cases for pseudarthrosis.
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Affiliation(s)
| | - Eric Lioret
- Department of Neurosurgery, Vinci Clinic, Tours, France
| | | | | | | | | | | | - Maja Ogielska
- Department of Infectious Diseases, Vinci Clinic, Tours, France
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13
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Raitio A, Saarinen AJ, Sinikumpu JJ, Helenius I. Biodegradable biomaterials in orthopedic surgery: A narrative review of the current evidence. Scand J Surg 2024; 113:62-70. [PMID: 37817459 DOI: 10.1177/14574969231200650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Biomaterials are routinely used in orthopedic surgery to fill bone defects, improve bone healing, and as degradable fixation material. A wide range of materials are currently in use, and the materials are chosen according to their bioactive properties. Osteoinductive materials stimulate bone healing by promoting osteogenesis. Osteoconductive materials facilitate bone growth on the surface of the material. Despite the many materials in use and an increasing number of published studies, randomized controlled trials on the subject are scarce. METHODS This review aims to summarize the history of biodegradable biomaterials and also the published level I evidence currently available on orthopedic biomaterials. RESULTS Most of the studies have been superiority trials with non-significant differences compared to conventional treatment options, confirming that several biomaterials are suitable treatment options for multiple indications including bone and/or tendon fixation, filling bone defects, and spinal fusion. Biomaterials help to avoid donor site complications associated with autogenous bone grafts and often eliminate the need for implant removal. However, the surgical technique may in some cases be more demanding than with conventional methods. Careful consideration of the pros and cons is therefore recommended in clinical practice. CONCLUSION Biodegradable biomaterials complement the range of available treatment options in several fields of orthopedic surgery. However, some biomaterials performed worse than expected and were not recommended for clinical use, emphasizing the need for high-quality randomized trials. It is also noteworthy that several trials included only a limited number of patients, rendering the interpretation of the results of these underpowered studies challenging.
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Affiliation(s)
- Arimatias Raitio
- Arimatias Raitio Department of Pediatric SurgeryUniversity of Turku and Turku University Hospital Turku Finland
- Turku University Hospital, Savitehtaankatu 5, 20520 Turku
| | - Antti J Saarinen
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Pediatric Surgery and Orthopedics, Clinical Medicine Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Ilkka Helenius
- Department of Pediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Henderson VK, Brismée JM. Pediatric neck pain of a 10-year-old child with cervical spinal tumor evaluated and managed in direct access physical therapy: a case report. J Man Manip Ther 2024:1-8. [PMID: 38415682 DOI: 10.1080/10669817.2024.2319427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Differential diagnosis of pediatric neck pain requires age-appropriate communication and assessment tools. Recognizing these age-related nuances is critical, emphasizing the role of physical therapists in assessing and managing pediatric patients while ruling out severe pathologies. CASE DESCRIPTION A 10-year-old male presented to physical therapy with a five-week history of increasing neck pain. A thorough history and segmental cervical examination considering the patient's age and development, led to patient referral to the emergency department. This case underscores the significance of comprehensive evaluation in pediatric neck pain management. OUTCOMES The patient was diagnosed with Langerhans Cell Histiocytosis (LCH). LCH primarily affects children and is treated with chemotherapy. Chemotherapy reduced the tumor, revealing C2 vertebral body damage. The patient underwent C1-C3 fusion surgery, a standard procedure for atlanto-occipital region stabilization in children. The patient was advised to restrict motion for 6 months while monitoring for tumor growth. DISCUSSION-CONCLUSION Pediatric neck cancer presents diagnostic challenges due to varied symptoms, but research highlights specific indicators to assist with differential diagnosis. This case emphasizes the need to recognize the complexities of pediatric neck pain and perform a thorough age-appropriate evaluation.
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Affiliation(s)
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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15
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Borja AJ, Gallagher RS, Karsalia R, Chauhan D, Malhotra EG, Punchak MA, Na J, McClintock SD, Schuster JM, Malhotra NR. Racial disparities in short-term spinal fusion outcomes across 4263 consecutive patients. J Neurosurg Spine 2024:1-6. [PMID: 38394654 DOI: 10.3171/2023.12.spine23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Race plays a salient role in access to surgical care. However, few investigations have assessed the impact of race within surgical populations after care has been delivered. The objective of this study was to employ an exact matching protocol to a homogenous population of spine surgery patients in order to isolate the relationships between race and short-term postoperative outcomes. METHODS In total, 4263 consecutive patients who underwent single-level, posterior-only lumbar fusion at a single multihospital academic medical center were retrospectively enrolled. Of these patients, 3406 patients self-identified as White and 857 patients self-identified as non-White. Outcomes were initially compared across all patients via logistic regression. Subsequently, White patients and non-White patients were exactly matched on the basis of key demographic and health characteristics (1520 matched patients). Outcome disparities were evaluated between the exact-matched cohorts. Primary outcomes were readmissions, emergency department (ED) visits, reoperations, mortality, intraoperative complications, and discharge disposition. RESULTS Before matching, non-White patients were less likely to be discharged home and more likely to be readmitted, evaluated in the ED, and undergo reoperation. After matching, non-White patients experienced higher rates of nonhome discharge, readmissions, and ED visits. Non-White patients did not have more surgical complications either before or after matching. CONCLUSIONS Between otherwise similar cohorts of spinal fusion cases, non-White patients experienced unfavorable discharge disposition and higher risk of multiple adverse postoperative outcomes. However, these findings were not accounted for by differences in surgical complications, suggesting that structural factors underlie the observed disparities.
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Affiliation(s)
- Austin J Borja
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ryan S Gallagher
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ritesh Karsalia
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daksh Chauhan
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emelia G Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Maria A Punchak
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jianbo Na
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
| | - Scott D McClintock
- 3West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - James M Schuster
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
| | - Neil R Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
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Wacker EM, Schultz L, Leitsinger N, Jain VV, Sturm PF. Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes. Healthcare (Basel) 2024; 12:489. [PMID: 38391864 PMCID: PMC10887821 DOI: 10.3390/healthcare12040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
Progressive spinal curvature in juvenile idiopathic scoliosis (JIS) is challenging to treat. When conservative management fails, treatments include growing rods (GRs) or posterior spinal fusion (PSF). The purpose of this study is to compare the patient characteristics and outcomes of GR and PSF treatment of JIS. We performed a retrospective review of demographic, radiographic, and surgical data for all JIS patients requiring surgical treatment between 2012 and 2020. Patients who underwent any GR treatment were compared to PSF patients. A total of 36 patients (13 GR, 23 PSF) were reviewed. PSF patients had a larger pre-operative spinal height (p = 0.002), but similar pre-operative major curve magnitudes (p = 0.558). PSF treatment resulted in similar change in the T1-S1 length (p = 0.002), but a greater correction of the curve magnitude (p < 0.055) compared to GR patients. Eight patients initially treated with GRs later underwent definitive PSF treatment. This subset of patients had a greater spinal height before PSF (p = 0.006), but similar immediate post-PSF T1-S1 lengths (p = 0.437) and smaller changes in spinal height from PSF (p = 0.020) than primary PSF patients. At final follow-up, patients who underwent primary PSF versus PSF after GR had similar spinal heights (p = 0.842). The surgical intervention chosen to manage progressive JIS often differs based on patient characteristics. While this choice may impact immediate outcomes, the outcomes at final follow up are similar.
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Affiliation(s)
- Elizabeth M Wacker
- University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Lindsay Schultz
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nichole Leitsinger
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Viral V Jain
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Bui AT, Le H, Hoang TT, Trinh GM, Shao HC, Tsai PI, Chen KJ, Hsieh KLC, Huang EW, Hsu CC, Mathew M, Lee CY, Wang PY, Huang TJ, Wu MH. Development of End-to-End Artificial Intelligence Models for Surgical Planning in Transforaminal Lumbar Interbody Fusion. Bioengineering (Basel) 2024; 11:164. [PMID: 38391650 PMCID: PMC10885900 DOI: 10.3390/bioengineering11020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Transforaminal lumbar interbody fusion (TLIF) is a commonly used technique for treating lumbar degenerative diseases. In this study, we developed a fully computer-supported pipeline to predict both the cage height and the degree of lumbar lordosis subtraction from the pelvic incidence (PI-LL) after TLIF surgery, utilizing preoperative X-ray images. The automated pipeline comprised two primary stages. First, the pretrained BiLuNet deep learning model was employed to extract essential features from X-ray images. Subsequently, five machine learning algorithms were trained using a five-fold cross-validation technique on a dataset of 311 patients to identify the optimal models to predict interbody cage height and postoperative PI-LL. LASSO regression and support vector regression demonstrated superior performance in predicting interbody cage height and postoperative PI-LL, respectively. For cage height prediction, the root mean square error (RMSE) was calculated as 1.01, and the model achieved the highest accuracy at a height of 12 mm, with exact prediction achieved in 54.43% (43/79) of cases. In most of the remaining cases, the prediction error of the model was within 1 mm. Additionally, the model demonstrated satisfactory performance in predicting PI-LL, with an RMSE of 5.19 and an accuracy of 0.81 for PI-LL stratification. In conclusion, our results indicate that machine learning models can reliably predict interbody cage height and postoperative PI-LL.
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Affiliation(s)
- Anh Tuan Bui
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi 100000, Vietnam
| | - Hieu Le
- School of Computer and Communication Sciences, Swiss Federal Institute of Technology in Lausanne, 1015 Lausanne, Switzerland
| | - Tung Thanh Hoang
- Department of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi 100000, Vietnam
| | - Giam Minh Trinh
- Department of Trauma-Orthopedics, College of Medicine, Pham Ngoc Thach Medical University, Ho Chi Minh City 700000, Vietnam
- Department of Pediatric Orthopedics, Hospital for Traumatology and Orthopedics, Ho Chi Minh City 700000, Vietnam
| | - Hao-Chiang Shao
- Institute of Data Science and Information Computing, National Chung Hsing University, Taichung City 402, Taiwan
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan
| | - Kuan-Jen Chen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Research Center of Translational Imaging, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - E-Wen Huang
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu 30013, Taiwan
| | - Ching-Chi Hsu
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Mathew Mathew
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Po-Yao Wang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- TMU Biodesign Center, Taipei Medical University, Taipei 11031, Taiwan
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18
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Chen S, Croft AS, Bigdon S, Albers CE, Li Z, Gantenbein B. Conditioned Medium of Intervertebral Disc Cells Inhibits Osteo-Genesis on Autologous Bone-Marrow-Derived Mesenchymal Stromal Cells and Osteoblasts. Biomedicines 2024; 12:376. [PMID: 38397978 PMCID: PMC10886592 DOI: 10.3390/biomedicines12020376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Low back pain (LBP) is associated with the degeneration of human intervertebral discs (IVDs). Despite progress in the treatment of LBP through spinal fusion, some cases still end in non-fusion after the removal of the affected IVD tissue. In this study, we investigated the hypothesis that the remaining IVD cells secrete BMP inhibitors that are sufficient to inhibit osteogenesis in autologous osteoblasts (OBs) and bone marrow mesenchymal stem cells (MSCs). A conditioned medium (CM) from primary human IVD cells in 3D alginate culture was co-cultured with seven donor-matched OB and MSCs. After ten days, osteogenesis was quantified at the transcript level using qPCR to measure the expression of bone-related genes and BMP antagonists, and at the protein level by alkaline phosphatase (ALP) activity. Additionally, cells were evaluated histologically using alizarin red (ALZR) staining on Day 21. For judging ALP activity and osteogenesis, the Noggin expression in samples was investigated to uncover the potential causes. The results after culture with the CM showed significantly decreased ALP activity and the inhibition of the calcium deposit formation in alizarin red staining. Interestingly, no significant changes were found among most bone-related genes and BMP antagonists in OBs and MSCs. Noteworthy, Noggin was relatively expressed higher in human IVD cells than in autologous OBs or MSCs (relative to autologous OB, the average fold change was in 6.9, 10.0, and 6.3 in AFC, CEPC, and NPC, respectively; and relative to autologous MSC, the average fold change was 2.3, 3.4, and 3.2, in AFC, CEPC, and NPC, respectively). The upregulation of Noggin in residual human IVDs could potentially inhibit the osteogenesis of autologous OB and MSC, thus inhibiting the postoperative spinal fusion after discectomy surgery.
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Affiliation(s)
- Shuimu Chen
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, 3012 Bern, Switzerland
| | - Andreas S Croft
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, 3012 Bern, Switzerland
| | - Sebastian Bigdon
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Zhen Li
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopedics & Mechanobiology (TOM), Bone & Joint Program, Department for BioMedical Research (DBMR), Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
- Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, 3010 Bern, Switzerland
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Kapetanakis S, Gkantsinikoudis N, Tsioulas P, Bladowska J, Apostolakis S. Assessment of Health-Related Quality of Life in Patients With Traumatic Fractures Following Thoracolumbar Fusion: Short-Term Results. Cureus 2024; 16:e53861. [PMID: 38465058 PMCID: PMC10924666 DOI: 10.7759/cureus.53861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Thoracolumbar vertebral fractures (TVFs) constitute frequent injuries with specific therapeutic challenges and remarkable implications for affected individuals. The aim of this study is to investigate the alteration of overall health-related quality of life (HRQoL) in patients with traumatic TVFs undergoing thoracolumbar fusion surgery. MATERIALS AND METHODS A total of 72 patients with single-level traumatic thoracic or lumbar vertebral fractures (AO type A3 or A4) were enrolled in this prospective cohort study. All patients were subjected to thoracolumbar spinal fusion surgery with or without posterior decompression, being followed up for a two-year period. Clinical assessment was conducted via the implementation of the Visual Analog Scale (VAS) and 36-item Short-Form Survey Questionnaire (SF-36) for the evaluation of pain and HRQoL, respectively. Patient assessment was performed in determined postoperative follow-up intervals. RESULTS Recorded values of assessed outcome measures demonstrated a statistically significant improvement during the entire two-year follow-up period. This improvement was more pronounced throughout the first three to six postoperative months, subsequently demonstrating a plateau. No statistically significant correlation between age, SF-36, and VAS was found, with the exception of the bodily pain index, the improvement of which was observed to be positively correlated with age. Transient causalgia and cerebrospinal fluid leak were recorded in 5% of evaluated individuals. CONCLUSIONS Thoracolumbar fusion constitutes a safe and efficient option for the surgical management of single-level traumatic vertebral fractures. Nevertheless, rehabilitation is a lasting procedure that may last over six months until final amelioration is observed. Clinical improvement may be more pronounced in older patients, potentially due to different expectations.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Spine and Deformities, European Interbalkan Medical Center, Thessaloniki, GRC
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, GRC
| | | | - Paschalis Tsioulas
- 2nd Orthopaedic Department, General Hospital of Thessaloniki "Papageorgiou", Thessaloniki, GRC
| | - Joanna Bladowska
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, POL
- Department of Radiology, Wroclaw 4th Military Clinical Hospital, Wroclaw, POL
| | - Sotirios Apostolakis
- Department of Spine and Deformities, European Interbalkan Medical Center, Thessaloniki, GRC
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20
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Pressman E, Osburn B, Vivas A, Krafft P, Ljubimov V, Chen L, Mhaskar R, Alikhani P. Rhabdomyolysis after spinal fusion surgery: management schema and prevention of a catastrophic complication. Br J Neurosurg 2024; 38:29-34. [PMID: 33410353 DOI: 10.1080/02688697.2020.1866164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Rhabdomyolysis is a clinical syndrome with the potential to cause cardiac arrhythmias, renal failure, and even death. Currently, there are no studies regarding risk factors for developing post-operative rhabdomyolysis (POR) after spinal fusion surgeries. Our objective was to study risk factors associated with, and to develop a decision-making framework for post-operative rhabdomyolysis after spinal fusion surgery. METHODS We performed a retrospective cohort study of all spinal fusions of three or more levels over 2.25 years by a single surgeon at two centers. POR was defined as a creatine phosphokinase (CPK) greater than 2000 IU/L. RESULTS 76 surgical procedures on 72 patients were identified. Rate of POR in our cohort was 22% (17/76). Male sex was associated with POR (p < 0.05). Previously validated risk factors: younger age, lower ASA score, elevated BMI, higher pre-operative creatinine, increased intraoperative blood loss, specific surgical positions, and length of surgery, were not associated with POR. In a logistic regression model, male gender increases the odds of POR in all patients 5.82-fold (p = 0.047). In patients without a second surgery within seven days, a logistic regression model suggests each additional level fused via transpsoas approach, and male gender, increases the risk of POR 1.81-times (p = 0.015), and 6.26-times (p = 0.047), respectively. In patients with posterior fusions, a logistic regression model suggests increasing the number of lateral levels fused via transpsoas approach in the same surgery, and male gender, increases the risk of POR 1.68-times and 6.34-times, respectively. In these same subgroups, increased thickness of the psoas major in lateral transpsoas fusions increased risk of POR (p = 0.023, p = 0.046, respectively). CONCLUSIONS In spinal fusions, increasing the number of lateral levels fused via transpsoas approach, and male gender, predispose patients to increased risk of POR in those without a second surgery within seven days, and in those with a simultaneous posterior fusion.
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Affiliation(s)
- Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Brooks Osburn
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Andrew Vivas
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Paul Krafft
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Vladimir Ljubimov
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Liwei Chen
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Puya Alikhani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
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Muthu S, Viswanathan VK, Rodrigues-Pinto R, Cabrera JP, Ćorluka S, Martin CT, Collins MJ, Agarwal N, Wu Y, Wang JC, Meisel HJ, Buser Z. Do the Choice of Fusion Construct With and Without Autograft Influence the Fusion and Complication Rates in Patients Undergoing 1 or 2-Level Anterior Cervical Discectomy and Fusion Surgery? A PRISMA-Compliant Network Meta-Analysis. Global Spine J 2024; 14:59S-69S. [PMID: 36723507 PMCID: PMC10913905 DOI: 10.1177/21925682231154488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
STUDY DESIGN Network meta-analysis. OBJECTIVES To compare the fusion outcome and complications of different 1 or 2-level anterior cervical decompression and fusion (ACDF) constructs performed with and without the application of autografts. METHODS We performed an independent and duplicate search in electronic databases including PubMed, Embase, Web of Science, Cochrane, and Scopus for relevant articles published between 2000 and 2020. We included comparative studies reporting fusion rate and complications with and without the use of autografts in ACDF across 5 different fusion constructs. A network meta-analysis was performed in Stata, categorized based on the type of fusion constructs utilized. Fusion constructs were ranked based on p-score approach and surface under cumulative ranking curve (SUCRA) scores. The confidence of results from the analysis was appraised with Cochrane's CINeMA approach. RESULTS A total of 2216 patients from 22-studies including 6 Randomized Controlled Trials (RCTs) and 16 non-RCTs were included in network analysis. The mean age of included patients was 49.3 (±3.62) years. Based on our meta-analysis, we could conclude that use of autograft in 1- or 2-level ACDF did not affect the fusion and mechanical implant-related complications. The final fusion and mechanical complication rates were also not significantly different across the different fusion constructs. The use of plated constructs was associated with a significant increase in post-ACDF dysphagia rates [OR 3.42; 95%CI (.01,2.45)], as compared to stand-alone constructs analysed. CONCLUSION The choice of fusion constructs and use of autografts does not significantly affect the fusion and overall complication rates following 1 or 2-level ACDF surgery.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, India
| | - Vibhu Krishnan Viswanathan
- Orthopaedic Research Group, Coimbatore, India
- Department of Musculoskeletal Oncology, University of Calgary, Calgary, AB, Canada
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Portugal Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Hospital CUF Trindade, Porto, Portugal
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Christopher T Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael J Collins
- Department of Orthopedic Surgery, Tulane University, New Orleans, LA, USA
- Department of Neurosurgery, Tulane University, New Orleans, LA, USA
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Sato S, Nakao Y, Kumaki S, Sano S. A case of delayed dyspnea after corrective posterior fusion of the middle and lower cervical spine for dropped head syndrome. J Surg Case Rep 2024; 2024:rjae047. [PMID: 38370594 PMCID: PMC10873850 DOI: 10.1093/jscr/rjae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Dyspnea has been reported to occur following posterior occipitocervical fusion. However, there are no documented cases of dyspnea following posterior fixation of the middle and lower cervical spine without posterior occipitocervical fusion. An 80-year-old woman underwent corrective fusion from T4 to the ilium for kyphoscoliosis. Sixteen months later, the patient developed cervical kyphosis (dropped head syndrome) with proximal junctional kyphosis, leading to a pedicle subtraction osteotomy at T4 and an extended fixation to C2. On the sixth postoperative day, the patient experienced respiratory arrest, prompting a reoperation to reduce cervical lordosis, ultimately resolving the respiratory dysfunction. Excessive correction of cervical kyphosis should be avoided to prevent the occurrence of postoperative dyspnea, even in cases where posterior occipitocervical fusion has not been performed.
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Affiliation(s)
- Shinsuke Sato
- Department of Orthopaedic Surgery, Sanraku Hospital, 2-5, Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan
| | - Yusuke Nakao
- Department of Orthopaedic Surgery, Sanraku Hospital, 2-5, Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan
| | - Shingo Kumaki
- Department of Orthopaedic Surgery, Sanraku Hospital, 2-5, Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan
| | - Shigeo Sano
- Department of Orthopaedic Surgery, Sanraku Hospital, 2-5, Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan
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Pharis HF, DeGenova DT, Passias BJ, Manes TJ, Parizek G, Sybert D. The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting. Cureus 2024; 16:e53662. [PMID: 38455778 PMCID: PMC10917700 DOI: 10.7759/cureus.53662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. Results The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting. Conclusions This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.
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Affiliation(s)
| | | | | | | | - Grace Parizek
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Columbus, USA
| | - Daryl Sybert
- Orthopedic Surgery, Mount Carmel Health System, Columbus, USA
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24
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Mamdouhi T, Wang V, Echevarria AC, Katz A, Morris M, Zavurov G, Verma R. A Comprehensive Review of the Historical Description of Spine Surgery and Its Evolution. Cureus 2024; 16:e54461. [PMID: 38510905 PMCID: PMC10953613 DOI: 10.7759/cureus.54461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Major strides in the advancement of spine surgery came about in the 21st century. However, the extensive history of spine surgery can be traced back to long before this time. A clear description of the journey from a primitive yet accurate understanding of the human musculoskeletal system to today's modern aspects of spinal techniques is lacking. A narrative literature review was conducted to elucidate where spine surgery began and the techniques used that evolved over time. This review was conducted using PubMed and Google Scholar. Search terms used included "history of spine surgery," "evolution of spine surgery," "origins of spine surgery," "history of laminectomy," "history of spinal fusion," "history of lumbar interbody fusion," "minimally invasive spine surgery," and "navigation in spine surgery." We highlight the evolution of the basic understanding of anatomy and non-surgical and surgical techniques, including bracing, laminectomy, discectomy, and spinal fusion. The current evolution and integration of minimally invasive techniques, lumbar interbody fusion techniques, robotics, navigation, and motion preservation are discussed, as these are the major areas of focus for technological advancement. This review presents an overarching synopsis of the events that chronicle the progress made in spine surgery since its conception. The review uniquely contributes to the growing body of literature on the expansion of spine surgery and highlights major events in its history.
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Affiliation(s)
- Tania Mamdouhi
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Orthopedic Surgery, University of Michigan, Ann Arbor, USA
| | - Victoria Wang
- Orthopedic Surgery, University of Connecticut, Storrs, USA
| | | | - Austen Katz
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
| | - Matthew Morris
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Gabriel Zavurov
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
- Orthopedic Surgery, Spine Surgery, North Shore University Hospital, Manhasset, USA
| | - Rohit Verma
- Orthopedic Surgery, Northwell Health, Manhassett, USA
- Orthopedic Surgery, Spine Surgery, North Shore University Hospital, Manhasset, USA
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25
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Ge CY, Dong L, Xu ZW, Yang WL, Qian LX, Yang XW, Hao DJ. Avulsion fracture of the anterior superior iliac crest following autograft for anterior lumbar fusion: case report and literature review. Front Surg 2024; 11:1327028. [PMID: 38327545 PMCID: PMC10847530 DOI: 10.3389/fsurg.2024.1327028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Avulsion fracture of the anterior superior iliac crest (ASIC) following autogenous bone grafting for anterior lumbar fusion (ALF) is an extremely rare complication. We describe a very rare case of avulsion fracture of the ASIC following autograft for ALF in a revision surgery for treating lumbar tuberculosis. A 68-year-old woman with lumbar tuberculosis underwent posterior debridement and posterior iliac crest bone graft fusion; however, her lumbar tuberculosis recurred 9 months after surgery. She then underwent a lumbar revision surgery, including removal of the posterior instrumentation and debridement, followed by anterior L2 corpectomy, debridement, anterior left iliac crest bone graft fusion, and internal fixation. When walking for the first time on postoperative day 3, she experienced a sharp, sudden-onset pain in the anterior iliac crest harvest area. X-ray revealed an avulsion fracture of the ASIC. Considering her failure to respond to conservative treatment for one week and large displacement of the fracture ends, an open reduction and internal fixation surgery was scheduled. Her pain symptoms were significantly relieved after the operation. Although rare, fracture of the ASIC following autograft for ALF should not be ignored. Fracture of the ASIC is usually treated conservatively. Additional surgical treatment is required only when intractable pain fails to respond to conservative treatment or when there is a large displacement of fracture ends that are not expected to heal spontaneously.
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Affiliation(s)
| | | | | | | | | | | | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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26
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Smith RA, Pease TJ, Chiu AK, Shear BM, Sahlani MN, Ratanpal AS, Ye IB, Thomson AE, Bivona LJ, Jauregui JJ, Crandall KM, Sansur CA, Cavanaugh DL, Koh EY, Ludwig SC. The Utility of the Validated Intraoperative Bleeding Scale in Thoracolumbar Spine Surgery: A Single-Center Prospective Study. Global Spine J 2024:21925682241228219. [PMID: 38265016 DOI: 10.1177/21925682241228219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
STUDY DESIGN Prospective, single-center study. OBJECTIVE To evaluate the clinical relevance of the validated intraoperative bleeding severity scale (VIBe) in thoracolumbar spine surgery. METHODS Adult patients aged 18 through 88 undergoing elective decompression, instrumentation, and fusion of the thoracolumbar spine were prospectively enrolled after informed consent was provided and written consent was obtained. Validated intraoperative bleeding severity scores were recorded intraoperatively. Univariate analysis consisted of Student T-tests, Pearson's χ2 Tests, Fisher's Exact Tests, linear regression, and binary logistic regression. Multivariable regression was conducted to adjust for baseline characteristics and potential confounding variables. RESULTS A total of N = 121 patients were enrolled and included in the analysis. After adjusting for confounders, VIBe scores were correlated with an increased likelihood of intraoperative blood transfusion (β = 2.46, P = .012), postoperative blood transfusion (β = 2.36, P = .015), any transfusion (β = 2.49, P < .001), total transfusion volume (β = 180.8, P = .020), and estimated blood loss (EBL) (β = 409, P < .001). Validated intraoperative bleeding severity scores had no significant association with length of hospital stay, 30-day readmission, 30-day reoperation, 30-day emergency department visit, change in pre- to post-op hemoglobin and hematocrit, total drain output, or length of surgery. CONCLUSION The VIBe scale is associated with perioperative transfusion rates and EBL in patients undergoing thoracolumbar spine surgery. Overall, the VIBe scale has clinically relevant meaning in spine surgery, and shows potential utility in clinical research. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ryan A Smith
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Tyler J Pease
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Anthony K Chiu
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Brian M Shear
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Mario N Sahlani
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Amit S Ratanpal
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ivan B Ye
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexandra E Thomson
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Louis J Bivona
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julio J Jauregui
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kenneth M Crandall
- Division of Spine Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles A Sansur
- Division of Spine Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel L Cavanaugh
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Y Koh
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven C Ludwig
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
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27
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Li CR, Chen SH, Chen WH, Tsou HK, Tzeng CY, Chen TY, Lin MS. A Retrospective Observational Study to Evaluate Adjacent Segmental Degenerative Change with the Dynesys-Transition-Optima Instrumentation System. J Clin Med 2024; 13:582. [PMID: 38276088 PMCID: PMC10816879 DOI: 10.3390/jcm13020582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND This study evaluates the impact of hybrid dynamic stabilization using the Dynesys-Transition-Optima (DTO) system on adjacent segment disease (ASD) in lumbar spinal stenosis patients with spondylolisthesis. METHODS From 2012 to 2020, 115 patients underwent DTO stabilization at a single center by a single neurosurgeon. After exclusions for lack of specific stabilization and incomplete data, 31 patients were analyzed. Follow-up was conducted at 6, 12, and 24 months postoperatively, assessing disc height, listhesis distance, and angular motion changes at L2-L3, L3-L4, and L5-S1. RESULTS L3-L4 segment (the index level), demonstrated a delayed increase in listhesis distance, contrasting with earlier changes in other segments. At two years, L3-L4 exhibited less increase in listhesis distance and less disc height reduction compared to L2-L3 and L5-S1. Notably, the L3-L4 segment showed a significant reduction in angular motion change over two years. CONCLUSIONS In conclusion, while ASD was not significantly prevented, the study indicates minor and delayed degeneration at the index level. The L3-L4 segment experienced reduced angular change in motion, suggesting a potential benefit of DTO in stabilizing this specific segment.
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Affiliation(s)
- Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-R.L.); (M.-S.L.)
| | - Shih-Hao Chen
- Department of Orthopaedics, Tzuchi General Hospital, Taichung 427, Taiwan;
| | - Wen-Hsien Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Tse-Yu Chen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-R.L.); (M.-S.L.)
| | - Mao-Shih Lin
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-R.L.); (M.-S.L.)
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Bouchard A, Mun J, Vazquez F, Tang A, Delsole E, Strom R, Chen T. Radiographic Robustness of Lumbar Interbody Fusion Techniques. Global Spine J 2024:21925682241226659. [PMID: 38197369 DOI: 10.1177/21925682241226659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES Lumbar interbody fusion (LIF) can be achieved with various techniques. Evidence supporting the long-term clinical advantages of one technique over another are inconclusive. The purpose of this study was to (1) determine the changes in sagittal parameters in the preoperative, intraoperative, and post-operative phase, (2) evaluate the radiographic maintenance of these parameters over time, and (3) compare the demographics and patient reported outcomes of patients undergoing various LIF techniques. METHODS We performed a retrospective chart review of patients with degenerative spine disease undergoing single level anterior (ALIF), lateral (LLIF), posterior (PLIF), or transforaminal (TLIF) lumbar interbody fusion. Data collected included patient demographics and diagnosis at time of surgery. Upright lumbar radiographs taken pre-operatively, intra-operatively, and post-operatively were measured for lumbar lordosis (LL), segmental lordosis (SL), posterior disc height (PDH), and foraminal height (FH). RESULTS 194 patients in a single center were included. PDH and FH increased intra-operatively following ALIF (P < .0001), PLIF (P < .0001), LLIF (P < .0001), and TLIF (P < .0001). SL also increased intra-operatively for ALIF (P = .002) and LLIF (P = .0007). Compared to intra-operative radiographs, PDH and FH decreased at latest post-operative phase for ALIF (P < .03), LLIF (P < .003), TLIF (P < .001), and PLIF (P < .005). SL decreased for ALIF (P = .0008), and TLIF (P = .02). LL did not change postoperatively across techniques. Patient reported outcomes improved post-surgically and disability index decreased, but neither differed between techniques. CONCLUSION LIF, regardless of technique, was shown to provide significant radiographic changes in PDH and FH. Techniques utilizing larger intervertebral cage sizes (ALIF/LLIF) improved SL. Single level LIF did not affect overall LL. No single technique displayed superior radiographic robustness over time.
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Affiliation(s)
- Alice Bouchard
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Jeffrey Mun
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Frank Vazquez
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Alex Tang
- Northeast Orthopaedic Surgery Residency, Geisinger, Wilkes-Barren, PA, USA
| | - Edward Delsole
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Russell Strom
- Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA
| | - Tan Chen
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
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29
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Graham BC, Lucasti C, Scott MM, Baker SC, Vallee EK, Patel DV, Hamill CL. Does Surgical Day of the Week Affect Hospital Course and Outcomes for Patients Undergoing Adult Spinal Deformity Surgery? Global Spine J 2024:21925682241226821. [PMID: 38197607 DOI: 10.1177/21925682241226821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Analysis. OBJECTIVES Extended hospital length of stay (LOS) poses a significant cost burden to patients undergoing adult spinal deformity (ASD) surgery. The purpose of this study is to investigate the relationship between late-week surgery and LOS in patients undergoing ASD surgery. METHODS 256 patients who underwent ASD surgery between January 2018 and December 2021 by a single fellowship-trained orthopedic spine surgeon comprised the patient sample. Demographics, intraoperative, and perioperative data were collected for the 256 patients who underwent ASD surgery. Patients were divided into two groups based on surgical day of the week: (1) Early-week (Monday/Tuesday) n = 126 and (2) Late-week (Thursday/Friday) n = 130. Descriptive statistics, T-tests, and linear and logistic regression models were used to analyze the data. RESULTS Surgical details and sociodemographic characteristics did not differ between the groups. When controlling for TLIF/DLIF status and PSO status there was no difference in mean length of stay between the groups. The late-week group was associated with a greater risk of 30-day readmission, but there was no difference in complications, infections, or intraoperative complications. CONCLUSIONS We found no difference in mean length of stay between surgeries performed early in the week vs late in the week. Although late-week surgeries had higher 30-day readmission risk, all other outcomes, including complication rates, showed no significant differences. When adequate weekend post-operative care is available, we do not advise restricting ASD surgeries to specific weekdays.
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Affiliation(s)
- Benjamin C Graham
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Christopher Lucasti
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
| | - Maxwell M Scott
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Seth C Baker
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Emily K Vallee
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Dil V Patel
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
| | - Christopher L Hamill
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
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30
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Hisatomi O, Fujiyoshi T, Shinotsuka S, Saiwai H, Higashi M, Yamaura K. Delayed Emergence from Total Intravenous Anesthesia Following Posterior Spinal Correction and Fusion for Scoliosis: A Case Report. Am J Case Rep 2024; 25:e941563. [PMID: 38192096 PMCID: PMC10788232 DOI: 10.12659/ajcr.941563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/07/2023] [Accepted: 11/09/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Postoperative acute liver failure, a complication following spine surgery, can cause delayed emergence from total intravenous anesthesia. Here, we report a case of acute severe postoperative liver failure following posterior spinal correction and fusion in a patient with congenital scoliosis. CASE REPORT A girl's congenital scoliosis worsened, and posterior spinal correction and fusion was scheduled. General anesthesia was induced with sevoflurane, fentanyl, target-controlled-infusion with propofol, and rocuronium. General anesthesia was maintained using target-controlled-infusion with propofol and remifentanil. The operation was completed with no remarkable complications. The operative time was 516 min and the anesthesia time was 641 min in the prone position. Emergence from anesthesia was poor, and it took 68 min to remove the tracheal tube after discontinuation of the anesthetic agents. The patient was drowsy and was transferred to her room in a general ward without reporting any pain, nausea, or dyspnea. On postoperative day 1, the results of laboratory investigations were suggestive of acute liver failure; contrast-enhanced computed tomography revealed a poorly enhanced area in the umbilical portion of the left liver lobe portal vein, indicating ischemic liver damage. Although no additional treatment was administered for acute liver failure, the patient recovered over time, and laboratory values normalized. No other postoperative complications were observed, and the patient was discharged on postoperative day 1. CONCLUSIONS Delayed emergence from general anesthesia may be due to acute liver failure following posterior spinal correction and fusion. There are several possible causes of postoperative liver failure, including anesthetics, prone position, and spinal surgery.
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Affiliation(s)
- Osamu Hisatomi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | | | - Sho Shinotsuka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
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Mohani MR, Arya N, Ratnani G, Harjpal P, Phansopkar P. Comprehensive Rehabilitation of a Patient With Foot Drop Secondary to Lumbar Canal Stenosis: A Case Report. Cureus 2024; 16:e52275. [PMID: 38357075 PMCID: PMC10864693 DOI: 10.7759/cureus.52275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
One of the most prevalent degenerative musculoskeletal conditions is lumbar spinal canal stenosis (LSS), which is characterized by narrowing of the lumbar spinal canal that pressures the nerve roots and cauda equine. LSS, when treated surgically, usually presents with foot drop as its major complication. Foot drop is a common presentation of several clinical diseases, traditionally characterized as severe weakening of ankle and toe dorsiflexion. Foot drop has a great impact on patients' lives, lowering their quality of life and affecting their activities of daily living. Ankle dorsiflexion weakness leads to foot drop and a high-stepping gait, which can cause multiple falls and accidents. This case study aimed to assess the efficacy of a customized physiotherapy program in a 50-year-old woman with paraparesis along with left foot drop and post-surgery complications following lumbar decompression and spinal fusion at L3-S1 (lumbar-sacral) level after a jerk experienced by her while working out in the gym. The objective was to determine the impact of individualized exercises on the patient's strength, gait, balance, and pelvic floor function over a 12-week rehabilitation period. The interventions included lower limb exercises (stretching exercises, strengthening exercises, and weight-bearing exercises), pelvic floor exercises, and core stability training. The findings demonstrated significant improvements in the patient's functional outcomes, as evidenced by enhanced scores in the Berg Balance Scale, Manual Muscle Testing, Dynamic Gait Index, Barthel Index, and Stanmore Assessment Questionnaire. Notable progress was observed in the strength, balance, gait, and pelvic floor function, highlighting the positive influence of targeted physiotherapeutic interventions. This case underscores the importance of tailored exercise plans in addressing the complexities of post-surgery challenges, emphasizing the potential for comprehensive recovery and improved overall quality of life through personalized physiotherapy.
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Affiliation(s)
- Mahek R Mohani
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Arya
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Grisha Ratnani
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Derman PB, Rogers-LaVanne MP, Satin AM. Minimally Invasive Revision of Luque Plate Instrumentation: A Case Report. Cureus 2024; 16:e53120. [PMID: 38420078 PMCID: PMC10899093 DOI: 10.7759/cureus.53120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Extension of existing spinal fusions may necessitate the removal of or linkage to prior constructs. Knowledge of previously placed instrumentation is critical to success in these revision scenarios. The Luque spinal instrumentation system, developed in the late 1980s, is a legacy pedicle screw and plate system that may be encountered during revision operations today. A 67-year-old male with a remote history of L4-S1 fusion with Luque instrumentation presented with bilateral lower extremity neurogenic claudication due to adjacent segment disease at L3-4. Decompression and extension of fusion to the L3-4 level were performed using minimally invasive techniques. Of note, posterior instrumentation was extended by removing prior L4 pedicle screws with a 7 mm female hexagonal driver through tubular retractors, leaving the Luque plates in place, placing modern pedicle screws at L4 (through the plates) and L3, and linking these with standard rods. The surgery and post-operative course were uncomplicated, and the patient experienced complete resolution of his pre-operative claudication symptoms. Extension of prior Luque plate instrumented fusion can be accomplished minimally invasively without removing the plates themselves, resulting in greater operative efficiency and less surgical morbidity.
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Affiliation(s)
- Peter B Derman
- Department of Spine Surgery, Texas Back Institute, Plano, USA
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Liu F, Liu F, Wang H. Half of the adolescent idiopathic scoliosis patients may have lumbar adjacent segment degeneration following spinal fusion: A systemic review and meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241248711. [PMID: 38647667 DOI: 10.1177/10225536241248711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This study aims to assess the impact of surgical approaches and other factors on the incidence of Adjacent Segment Degeneration (ASD) following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS). METHODS We conducted a comprehensive search of four electronic databases from their inception until March 30, 2023. Two independent reviewers screened titles, abstracts, and full texts and evaluated the methodological quality of the studies. A random-effects model was used to calculate the incidence of ASD. RESULTS Our analysis included 14 studies involving 651 individuals. The overall incidence of ASD was 47% (95%CI: 0.37, 0.56). Subgroup analyses revealed that the prevalence of ASD increased with postoperative time (53% (95%CI: 0.31, 0.75) versus 48% (95%CI: 0.36, 0.60) versus 39% (95%CI: 0.22, 0.56)). For the number of fused segments, a group with more than 10 segments had a higher prevalence (49% (95%CI: 0.38, 0.60) versus 44% (95%CI: 0.21, 0.69)). In terms of regions, East Asia had the highest prevalence, followed by Occident and West Asia (52% (95%CI: 0.41, 0.62) versus 43% (95%CI: 0.20, 0.68) versus 37% (95%CI: 0.17, 0.59)). However, the surgical approach, male ratio, and the position of the lowest instrumented vertebra (LIV) did not show significant differences between groups. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: t = 1.62, p-value = .1274). CONCLUSION This meta-analysis found that nearly half of AIS patients following spinal fusion surgery experienced ASD. Long-term follow-up, regular screening, and timely interventions are essential to reduce the prevalence of ASD.
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Affiliation(s)
- Fuze Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Fuhui Liu
- School of Clinical Medical, Weifang Medical University, Weifang, China
| | - Hai Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Bhoge SS, Athawale V, Fating T. Rehabilitation of a Patient With D12 Wedge Compression Fracture and Bilateral Foot Drop With Spinal Fusion and Posterior Decompression: A Case Report. Cureus 2024; 16:e51561. [PMID: 38313983 PMCID: PMC10835512 DOI: 10.7759/cureus.51561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Vertebral fracture (VF) is one of the most common injuries seen in individuals with osteoporosis, especially in post-menopausal females. There is an increase in bone resorption rate, leading to the destruction of the microarchitecture of bone. A 67-year-old female patient diagnosed with wedge compression fracture of the D12 vertebra, mild compression of the spinal cord, and bilateral foot drop came to a tertiary care hospital, where she underwent spinal fusion at the D11-L1 level and posterior decompression, after which she was referred to physiotherapy, where a patient-tailored treatment protocol was made and implemented over three weeks. Outcome measures like the visual analog scale (VAS), functional independence measure (FIM), and Oswestry's low back disability questionnaire were recorded before and after rehabilitation, and improvement in pain and activities of daily living (ADL) was found. The patient needed mild assistance. There was also improvement in the range and strength of the lower limb muscles. This case report aims to provide a comprehensive treatment protocol for a post-operative spinal fusion and bilateral foot drop patient.
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Affiliation(s)
- Shruti S Bhoge
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Athawale
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Marie-Hardy L, Khalifé M, Pietton R, Rollet ME, Boissière L, Cohen-Bittan J, Pascal-Moussellard H. Does Spinal Surgery in Elderly Patients (Over 80 Years-Old) Lead to More Early Post-Operative Complications Than Lower Limb Prosthetic Surgery? Gerontol Geriatr Med 2024; 10:23337214231225841. [PMID: 38250569 PMCID: PMC10798125 DOI: 10.1177/23337214231225841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/25/2023] [Accepted: 12/09/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose: Patients and surgeons may be reluctant on spinal surgery over 80 years old, fearing medical complications despite the possible improvement on quality of life. However, fewer reservations for lower limb prosthetic surgery (LLPS) seem to be arisen in this population. Is spinal surgery after 80 years-old responsible of more complications than lower limb surgery? Methods: The consecutive files of 164 patients over 80 years that had spinal surgery or LLPS were analyzed. The data collected pre-operatively were demographic, clinical and post-operatively the number and types of medical complications and length of stay. Results: The mean number of medical complications was 1.11 ± 0.6 [0-6] for spinal surgery and 1.09 ± 1.0 [0-3] for LLPS, (p = 0,87). The length of stay in orthopedic unit was comparable between the two groups: 10.7 ± 4.9 days [2-36] for SS and 10.7 ± 3.0 days [5-11] for LLPS (p = 0,96). Conclusion: The global rate of peri-operative complications and the length of hospital stay were similar between spinal surgery and lower limb prosthetic surgery. These results may be explained by the rising cooperation between geriatric specialist and surgeons and the development of mini-invasive surgical technics, diminishing the early post-operative complication rates.
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Affiliation(s)
- Laura Marie-Hardy
- Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Khalifé
- Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, Paris, France; Université de Paris, Paris, France
| | - Raphaël Pietton
- Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Eva Rollet
- Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - L. Boissière
- Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - J. Cohen-Bittan
- Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
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36
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Wang JL, Eaton RG, Harrigan ME, Munjal V, Sette KN, Wilson SB, Grossbach AJ. Demineralized Bone Matrix and Fibers in Spinal Fusion. Int J Spine Surg 2023; 17:S28-S34. [PMID: 38135444 PMCID: PMC10753352 DOI: 10.14444/8558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/11/2023] [Indexed: 12/24/2023] Open
Abstract
Formation of bony fusion after arthrodesis depends on osteoinduction, osteoconduction, and osteogenesis. Traditionally, the patient's own bone, or autograft, has been used to provide biological material necessary for these steps. However, the amount of autograft obtainable is often inadequate. Modern spine surgery has adopted the use of many autograft extenders or replacements, such as demineralized bone matrix or fibers. The present article covers the history of bone grafting, the production and technical details of demineralized bone matrix, and the evidence supporting its use in spine fusions.
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Affiliation(s)
- Joshua L Wang
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ryan G Eaton
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Markus E Harrigan
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Vikas Munjal
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katelyn N Sette
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Seth B Wilson
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew J Grossbach
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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37
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Croft AJ, Chanbour H, Chen JW, Young MW, Stephens BF. Implant Surface Technologies to Promote Spinal Fusion: A Narrative Review. Int J Spine Surg 2023; 17:S35-S43. [PMID: 38050045 PMCID: PMC10753326 DOI: 10.14444/8559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
The technology surrounding spinal fusion surgery has continuously evolved in tandem with advancements made in bioengineering. Over the past several decades, developments in biomechanics, surgical techniques, and materials science have expanded innovation in the spinal implant industry. This narrative review explores the current state of implant surface technologies utilized in spinal fusion surgery. This review covers various types of implant surface materials, focusing on interbody spacers composed of modified titanium, polyetheretherketone, hydroxyapatite, and other materials, as well as pedicle screw surface modifications. Advantages and disadvantages of the different surface materials are discussed, including their biocompatibility, mechanical properties, and radiographic visibility. In addition, this review examines the role of surface modifications in enhancing osseointegration and reducing implant-related complications and, hopefully, improving patient outcomes. The findings suggest that while each material has its potential advantages, further research is needed to determine the optimal surface properties for enhancing spinal fusion outcomes.
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Affiliation(s)
- Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W Chen
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mason W Young
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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38
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Kim E, Brennan M, Margabandu P, Oska N, Cielito Robles M, Rademacher A, Telemi E, Mansour T, Chang VW. Bone Grafting Options for Single-Level TLIF: So Many Options, What Is the Evidence? Int J Spine Surg 2023; 17:S53-S60. [PMID: 38124018 PMCID: PMC10753332 DOI: 10.14444/8561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/08/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This review seeks to investigate the clinically relevant bone graft materials in single-level transforaminal lumbar interbody fusion (TLIF) procedures as defined by (1) primary outcomes (ie, fusion rates and complication rates) and (2) patient-reported outcomes (ie, visual analog scale [VAS] and Oswestry disability index [ODI]). Because of the advantages in stimulating bone growth, autologous bone grafts such as the iliac crest bone graft (ICBG) have been the gold standard. Numerous alternatives to ICBG have been introduced. Understanding the risks and benefits of bone graft options is vital to optimizing patient care. METHODS A PubMed search was performed for all clinical studies published between January 2008 and March 2023 that referenced the single-level TLIF procedure as well as one of the following grafts: autograft, allograft, bone morphogenetic protein (BMP), demineralized bone matrix, or mesenchymal stem cells (MSCs). Case studies and reports were excluded. RESULTS Twenty-eight studies met the inclusion criteria. Studies from the PubMed search demonstrated similarly high fusion rates across nearly all graft materials, the lone exception being MSCs, which showed lower fusion rates. ICBG grafts experienced higher rates of postoperative graft site pain. The BMP graft material had high rates of radiculitis, heterogeneous ossification, and vertebral osteolysis. Patients saw an overall improvement in VAS and ODI scores with all graft materials. CONCLUSION Local autografts and ICBG have been the most studied. Fusion rates during single-level TLIF were similar across all graft materials except MSCs. Patient-reported pain levels improved after TLIF surgery regardless of the type of grafts used. While BMP implants have shown promising benefits, they have introduced a new array of complications not normally seen in ICBG implants. The study is limited by the lack of evidence of certain graft materials as well as nonuniformity in metrics evaluating the efficacy of graft materials.
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Affiliation(s)
- Enoch Kim
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Matthew Brennan
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Nicole Oska
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | | | - Edvin Telemi
- Department of Neurosurgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Tarek Mansour
- Department of Neurosurgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Health Systems, Detroit, MI, USA
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39
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Scott-Young M, Nielsen D, Riar S. Fundamentals of Mechanobiology and Potential Applications in Spinal Fusion. Int J Spine Surg 2023; 17:S61-S74. [PMID: 38135446 PMCID: PMC10753328 DOI: 10.14444/8562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Mechanobiology can help optimize spinal fusion by providing insights into the mechanical environment required for bone healing and fusion. This includes understanding the optimal loading conditions, the mechanical properties of implanted materials, and the effects of mechanical stimuli on the cells involved in bone formation. The present article reviews the evidence for surface technologies and implant modification of spinal cages in enhancing spinal fusion. METHODS Databases used included Embase, MEDLINE, Springer, and Cochrane Library. Relevant articles were identified using specific keywords and search fields. Only systematic reviews, meta-analyses, review articles, and original research articles in English were included. Two researchers independently performed the search and selection process. A flowchart of the search strategy and study selection method is provided in the article. RESULTS The studies indicate that surface modification can significantly enhance osseointegration and interbody fusion by promoting cellular adhesion, proliferation, differentiation, and mineralization. Various surface modification techniques such as coating, etching, nanotopography, and functionalization achieve this. Similarly, implant material modification can improve implant stability, biocompatibility, and bioactivity, leading to better fusion outcomes. Mechanobiology plays a vital role in this process by influencing the cellular response to mechanical cues and promoting bone formation. CONCLUSIONS The studies reviewed indicate that surface technologies and implant material modification are promising approaches for improving the success of spinal cage fusion. Mechanobiology is critical in this process by influencing the cellular response to mechanical signals and promoting bone growth.
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Affiliation(s)
- Matthew Scott-Young
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
| | - David Nielsen
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
| | - Sukhman Riar
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
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40
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Bergin SM, Crutcher CL, Keeler C, Rocos B, Haglund MM, Michael Guo H, Gottfried ON, Richardson WJ, Than KD. Osteoimmunology: Interactions With the Immune System in Spinal Fusion. Int J Spine Surg 2023; 17:S9-S17. [PMID: 38050073 PMCID: PMC10753333 DOI: 10.14444/8556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Spinal fusion is important for the clinical success of patients undergoing surgery, and the immune system plays an increasingly recognized role. Osteoimmunology is the study of the interactions between the immune system and bone. Inflammation impacts the osteogenic, osteoconductive, and osteoinductive properties of bone grafts and substitutes and ultimately influences the success of spinal fusion. Macrophages have emerged as important cells for coordinating the immune response following spinal fusion surgery, and macrophage-derived cytokines impact each phase of bone graft healing. This review explores the cellular and molecular immune processes that regulate bone homeostasis and healing during spinal fusion.
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Affiliation(s)
- Stephen M Bergin
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - Clifford L Crutcher
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - Carolyn Keeler
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - Brett Rocos
- Department of Orthopedic Surgery, Division of Spine, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - H Michael Guo
- Department of Orthopedic Surgery, Division of Spine, Duke University, Durham, NC, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - William J Richardson
- Department of Orthopedic Surgery, Division of Spine, Duke University, Durham, NC, USA
| | - Khoi D Than
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
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41
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Mendiratta D, Para A, Berg AR, Vives MJ. Use of the Geriatric Nutritional Risk Index to Assess Risk for Postoperative Complications Following Posterior Cervical Decompression/Fusion. Int J Spine Surg 2023; 17:866-874. [PMID: 37884336 PMCID: PMC10753348 DOI: 10.14444/8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Posterior cervical decompression with or without fusion (PCD/F) is used to manage degenerative spinal conditions. Malnutrition has been implicated for poor outcomes in spine surgery. The aim of this study was to assess the ability of the Geriatric Nutritional Risk Index (GNRI) as a risk calculator for postoperative complications in patients undergoing PCD/F. METHODS The 2006 to 2018 American College of Surgeons National Surgery Quality Improvement Program Database was queried for patients undergoing PCD/F. Nutritional status was categorized as normal (GNRI greater than 98), moderately malnourished (GNRI 92-98), or severely malnourished (GNRI less than or equal to 92). Complications within 30 days of surgery were compared among the groups. Preoperative data that were statistically significant (P < 0.05) upon univariate χ2 analysis were included in the univariate then multivariate binary regression model to calculate adjusted ORs. All ORs were assessed at the 95% CI. RESULTS Of the 7597 PCD/F patients identified, 15.6% were severely malnourished and 19.1% were moderately malnourished. Severe and moderate malnourishment were independent risk factors for mortality (OR = 3.790, 95% CI 2.492-5.763, P < 0.001; OR = 2.150, 95% CI 1.351-3.421, P = 0.011). Severe malnourishment was an independent risk factor for sepsis/septic shock (OR = 3.448, 95% CI 2.402-4.948, P < 0.001). CONCLUSIONS In elderly patients undergoing PCD/F, severe malnutrition, as defined by the GNRI, was an independent risk factor for mortality and sepsis/septic shock. CLINICAL RELEVANCE The GNRI may be more useful than other indices for risk stratification in elderly patients because it accounts for confounding variables such as hydration status and paradoxical malnourishment in obese patients. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Dhruv Mendiratta
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ashok Para
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ari R Berg
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Michael J Vives
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
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Albayar A, Santangelo G, Spadola M, Macaluso D, Ali ZS, Saifi C, Heintz J, Han X, Bilker W, Malhotra N, Welch WC, Wathen C, Dagli MM, Ghenbot Y, Yoon J, Arlet V, Ozturk AK. Comparison of Staged vs Same-Day Circumferential Spinal Fusions for Adult Spinal Deformity. Int J Spine Surg 2023; 17:843-855. [PMID: 37827708 PMCID: PMC10753336 DOI: 10.14444/8548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of ST vs SD circumferential ASD corrective surgeries. METHODS This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 and 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW), and the results before and after IPW were compared. RESULTS The entire cohort included a total of 211 (ST = 50, SD = 161) patients, 100 of whom (ST = 44, SD = 56) underwent more than 4 levels fused posteriorly and anterior lumbar interbody fusion (ALIF). Although patient characteristics and comorbidities were not dissimilar between the ST and SD groups, both the number of levels fused in ALIF and posterior spinal fusion (PSF) were significantly different. Thus, using IPW, we were able to minimize the cohort incongruities in the number of levels fused in ALIF and PSF while maintaining comparable patient characteristics. In both the whole cohort and the long segment fusions, postoperative pulmonary embolism was more common in ST procedures. After adjustment utilizing IPW, both groups were not significantly different in disposition, 30-day readmissions, and reoperations. However, within the whole cohort and the long segment fusion cohort, the ST group continued to show significantly increased rates of pulmonary embolism, longer length of stay, and higher hospital admission costs compared with the SD group. CONCLUSIONS Adjusted comparisons between ST and SD groups showed staging associated with significantly increased length of stay, risk of pulmonary embolism, and admission costs. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Ahmed Albayar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gabrielle Santangelo
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Michael Spadola
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dominick Macaluso
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zarina S Ali
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Comron Saifi
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Heintz
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaoyan Han
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Warren Bilker
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mert Marcel Dagli
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jang Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Arlet
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Post AM, Berends HI, van Royen BJ. Minimally Invasive Posterior Spinal Nonfusion Surgery in Patients With Adolescent Idiopathic Scoliosis Using a Bipolar One-Way Self-Expanding Rod System: Protocol for a Single-Center Clinical Cohort Study. JMIR Res Protoc 2023; 12:e47222. [PMID: 38145474 PMCID: PMC10775021 DOI: 10.2196/47222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND The current surgical treatment for patients diagnosed with progressive and severe adolescent idiopathic scoliosis (AIS) consists of the correction of the spinal curvature, followed by posterior spinal fusion (PSF). However, research has uncovered short- and long-term complications of posterior spinal fusion in patients with AIS. Minimally invasive growing rod techniques have successfully been used to treat patients with early-onset scoliosis and neuromuscular scoliosis. It may be questioned if minimally invasive posterior spinal nonfusion (PSnF) surgery with bipolar instrumentation can be used for the treatment of AIS. OBJECTIVE This study will be performed to monitor the efficacy and safety of PSnF surgery by using a commercially available Conformité Européenne-certified spinal implant consisting of bilateral bipolar one-way self-expanding rods (OWSER) for the treatment of patients diagnosed with AIS. METHODS In 14 selected patients with AIS with Lenke 1-6 curves, minimally invasive PSnF surgery with the OWSER system is performed after the failure of conservative treatment (curve progression of >5° within 1 year). The patients are over 7 years of age, with a major Cobb angle of ≥30°, sufficient flexibility, and a Risser stage of ≤2. Patients will be followed over time, according to the standard medical care. Efficacy will be measured using radiological and patient satisfaction assessments and safety will be determined by the amount of perioperative complications. RESULTS Patient inclusion started on November 17, 2021 and we hope to finalize patient inclusion by the beginning of 2025. The first results will be expected by the beginning of 2024. CONCLUSIONS Minimally invasive PSnF in patients with AIS is presented as a less invasive surgical technique that prevents the progression of the scoliotic curve and that allows minor posture correction of coronal imbalance. This will be the first study to examine whether the PSnF bipolar OWSER instrumentation will be the next generation of surgical instrumentation in AIS. TRIAL REGISTRATION ClinicalTrials.gov NCT04441411; https://clinicaltrials.gov/study/NCT04441411. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47222.
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Affiliation(s)
- Anne Mareille Post
- Department of Orthopedic Surgery and Sports Medicine, University Medical Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Hanneke I Berends
- Department of Orthopedic Surgery and Sports Medicine, University Medical Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Barend J van Royen
- Department of Orthopedic Surgery and Sports Medicine, University Medical Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Amsterdam, Netherlands
- Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, Netherlands
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Chen C, Gao X, Li H, Pan X, Wang S. Intravertebral insertion of interbody fusion cage via transpedicular approach for the treatment of stage III Kümmell disease: a technical note and case presentation. Br J Neurosurg 2023; 37:1909-1914. [PMID: 33843392 DOI: 10.1080/02688697.2021.1892590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Kümmell disease usually occurs in the elderly osteoporosis population and develops gradually into symptomatic, progressive kyphosis of the spine. However, current surgical methods to deal with stage III Kümmell disease are less satisfying. The objective of this study was to describe a less invasive technique for treating stage III Kümmell disease. TECHNIQUE A less invasive technique of intravertebral insertion of interbody fusion cage via transpedicular approach with posterior spine stabilization was applied to treat stage III Kümmell disease. RESULTS This study details a modified technique applied in a patient with stage III Kümmell disease, showing significant improvement in pain relief, anterior column height recovery, and kyphotic angle correction. And no complications were reported during our follow-up. CONCLUSIONS Intravertebral insertion of interbody fusion cage via transpedicular approach provides advantages of acceptable correction of kyphosis, bony fusion, minimal invasion. Thus, our method was a good alternative choice for stage III Kümmell disease.
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Affiliation(s)
- Changjun Chen
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xianlei Gao
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Hao Li
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Xin Pan
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Songgang Wang
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
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Zhang JK, Dibble CF, Cashin J, Hajji S, Dorward I, Hawasli AH. Treatment of sacroiliac joint laxity-induced coronal imbalance with the kickstand rod technique. Br J Neurosurg 2023; 37:1732-1737. [PMID: 33612027 DOI: 10.1080/02688697.2021.1887452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Considerations of the sacroiliac joint (SIJ) and its role in causing lower back and limb pain have taken a secondary role ever since Mixter and Barr's hallmark article in 1934 on the herniated nucleus pulposus. However, recent literature has highlighted the contribution of sacroiliac joint degeneration in the development of failed back surgery syndrome (FBSS), especially in patients undergoing lumbar or lumbosacral spinal fusion surgeries. Many reports have studied the anatomy, physiology, and clinical significance of the sacroiliac joint, but none have linked its dysfunction with other spinal deformities. CASE DESCRIPTION A 63-year-old female with a history of multiple complex instrumented spinal fusions presented to our institution with progressive leftward coronal imbalance despite successful arthrodesis from T3 through S1. She was initially treated with decompression and reimplantation, but adjacent segment disease at the SIJ led to laxity, distal failure, and a worsening coronal deformity. A mechanical fall after her decompression surgery led to a dramatically increased coronal imbalance, which was ultimately treated using Lenke's kickstand rod technique. At 3.5 years follow up, the patient's coronal balance remains stable. CONCLUSION Few studies have related SIJ degeneration and laxity with spinal deformity. Our case describes SIJ degeneration that evolved to joint laxity, which ultimately produced a leftward coronal imbalance according to the adjacent segment disease mechanism. Additionally, we describe the use of a kickstand rod to effectively correct the coronal imbalance, reduce pain levels, promote SIJ arthrodesis, and prevent further SIJ-related issues without significant complications over 3 years post-operation.
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Affiliation(s)
- Justin K Zhang
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher F Dibble
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John Cashin
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Samer Hajji
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian Dorward
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ammar H Hawasli
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
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Taylor C, Metcalf A, Morales A, Lam J, Wilson R, Baribeault T. Multimodal Analgesia and Opioid-Free Anesthesia in Spinal Surgery: A Literature Review. J Perianesth Nurs 2023; 38:938-942. [PMID: 37452818 DOI: 10.1016/j.jopan.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 07/18/2023]
Abstract
PURPOSES To determine if opioid-free anesthesia, opioid-sparing anesthesia, or multimodal analgesia improved outcomes in patients undergoing spinal fusion. DESIGN A literature review was performed by searching PubMed, CINAHL, Embase, Web of Science, and Cochrane Library. METHODS MeSH terms included "opioid free" AND "spine surgery," with alternative terms used including: regional anesthesia, multimodal analgesia, opioid-free anesthesia, enhanced recovery after surgery (ERAS), spinal surgery, spinal fusion, ACDF, cervical fusion, lumbar fusion, etc. Seven studies were deemed appropriate for inclusion with a combined sample size of n = 2,102. FINDINGS All of the seven included articles evaluated total opioid administration and found a reduction in total opioid administered in the research groups versus control groups. Six of the seven included articles evaluated postoperative pain scores with mixed results. Various additional benefits of opioid-free, opioid-sparing, or multimodal analgesia included: decreased hospital length of stay (LOS), decreased post-anesthesia care unit (PACU) LOS, decreased post-operative nausea and vomiting (PONV), and decreased post-operative opioid use through 30 days. CONCLUSIONS For patients undergoing spine surgery, opioid-free, opioid-sparing, and multimodal analgesia will be less likely to experience the adverse effects of opioid analgesics and ultimately lead to better patient outcomes and reduced hospital stays.
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Affiliation(s)
- Charity Taylor
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC
| | - Amanda Metcalf
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC
| | - Anthony Morales
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC
| | - James Lam
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC
| | - Richard Wilson
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC
| | - Thomas Baribeault
- School of Medicine, Nurse Anesthesia Program, University of South Carolina, Columbia, SC.
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Li F, Huang X, Huang Y, Liang B, Yin D. The efficacy of temperature intervention combined with tranexamic acid in reducing blood loss and accelerating recovery during spinal fusion. Medicine (Baltimore) 2023; 102:e36407. [PMID: 38013275 PMCID: PMC10681552 DOI: 10.1097/md.0000000000036407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of temperature intervention combined with tranexamic acid (TXA) on perioperative blood loss during spinal fusion and accelerated rehabilitation. METHOD Between August 2014 and July 2019, 310 lumbar fusion at our hospital were randomly divided into 4 groups as follows. Group A (placebo): no TXA and no temperature intervention. Group B: TXA (15 mg/kg) before skin incision. Group C: TXA (15 mg/kg) before skin incision and temperature intervention. Group D: temperature intervention without TXA. The primary outcomes were intraoperative blood loss, postoperative blood loss, total blood loss, and core temperature at different stages. We also recorded the hemoglobin level, blood transfusion rate, prothrombin time on postoperative day 1 (POD1), length of hospital stay, and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). RESULTS The 4 groups showed statistically significant differences in intraoperative blood loss, postoperative blood loss, total blood loss, core temperature after anesthesia, average temperature during the operation, hemoglobin on POD1, and length of stay (P < .05). In contrast, prothrombin time on POD1 and the incidence of DVT or PE did not differ between the groups (P > .05). Comparing the transfusion rate in Group C (6/77, 7.79%) and Group A (17/78, 21.79%), the difference was statistically significant. CONCLUSION Temperature intervention combined with TXA can significantly reduce blood loss and the transfusion rate of spinal fusion in the perioperative period, reduce the length of stay and accelerate rehabilitation after surgery without increasing the incidence of DVT or PE.
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Affiliation(s)
- Fulin Li
- Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiao Huang
- Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu Huang
- Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Bin Liang
- Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dong Yin
- Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Hiyama A, Sakai D, Katoh H, Nomura S, Watanabe M. Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation. J Clin Med 2023; 12:6914. [PMID: 37959378 PMCID: PMC10647313 DOI: 10.3390/jcm12216914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Percutaneous pedicle screws (PPSs) are commonly used in posterior spinal fusion to treat spine conditions such as trauma, tumors, and degenerative diseases. Precise PPS placement is essential in preventing neurological complications and improving patient outcomes. Recent studies have suggested that intraoperative computed tomography (CT) navigation can reduce the dependence on extensive surgical expertise for achieving accurate PPS placement. However, more comprehensive documentation is needed regarding the procedural accuracy of lateral spine surgery (LSS). In this retrospective study, we investigated patients who underwent posterior instrumentation with PPSs in the thoracic to lumbar spine, utilizing an intraoperative CT navigation system, between April 2019 and September 2023. The system's methodology involved real-time CT-based guidance during PPS placement, ensuring precision. Our study included 170 patients (151 undergoing LLIF procedures and 19 trauma patients), resulting in 836 PPS placements. The overall PPS deviation rate, assessed using the Ravi scale, was 2.5%, with a notably higher incidence of deviations observed in the thoracic spine (7.4%) compared to the lumbar spine (1.9%). Interestingly, we found no statistically significant difference in screw deviation rates between upside and downside PPS placements. Regarding perioperative complications, three patients experienced issues related to intraoperative CT navigation. The observed higher rate of inaccuracies in the thoracic spine suggests that various factors may contribute to these differences in accuracy, including screw size and anatomical variations. Further research is required to refine PPS insertion techniques, particularly in the context of LSS. In conclusion, this retrospective study sheds light on the challenges associated with achieving precise PPS placement in the lateral decubitus position, with a significantly higher deviation rate observed in the thoracic spine compared to the lumbar spine. This study emphasizes the need for ongoing research to improve PPS insertion techniques, leading to enhanced patient outcomes in spine surgery.
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Affiliation(s)
- Akihiko Hiyama
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan; (D.S.); (H.K.); (S.N.); (M.W.)
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Hammon DE, Chidambaran V, Templeton TW, Pestieau SR. Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery. Paediatr Anaesth 2023; 33:894-904. [PMID: 37528658 DOI: 10.1111/pan.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake-up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence-based approaches covered in this review.
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Affiliation(s)
- Dudley E Hammon
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Thomas W Templeton
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sophie R Pestieau
- Department of Anesthesiology, Washington National, Washington, DC, USA
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Akinnusotu O, Isaacs AM, Stone M, Bonfield CM. Neurosurgical management of cervicomedullary compression, spinal stenosis, and hydrocephalus in pediatric achondroplasia: a systematic review. J Neurosurg Pediatr 2023; 32:597-606. [PMID: 37728398 DOI: 10.3171/2023.6.peds23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Pediatric achondroplasia is often associated with conditions requiring neurosurgical intervention, including CSF diversion and multilevel spinal decompression. However, there is a lack of clinical guidelines and reliable estimates of the benefits and risks of these interventions. This study aimed to summarize the literature on the neurosurgical management of pediatric achondroplasia patients in order to aid in determining optimal treatment and standardization of care. METHODS A systematic review of peer-reviewed studies with an objective diagnosis of achondroplasia, patient demographic information, and available data on neurosurgical interventions performed before 18 years of age for cervicomedullary compression, spinal stenosis, and hydrocephalus was performed. Study quality and risks of bias were assessed using standardized scores. Independent patient data on surgical indications, outcomes, reoperations, and complication risks were aggregated using means and percentages. RESULTS Of 204 records, 25 studies with 287 pediatric achondroplasia patients (mean age 25 ± 36 months) treated for cervicomedullary compression (n = 153), spinal stenosis (n = 100), and obstructive hydrocephalus (n = 34) were evaluated. Symptomatic cervicomedullary compression occurred early in life (mean age 31 ± 25 months), with apnea (48%), T2-weighted MRI cord signal (28%), myelopathy (27%), and delayed motor skills (15%) requiring foramen magnum decompression observed in 99% of patients, as well as cervical laminectomy in 65% of patients. Although 91% of treated patients had resolution of symptoms, 2% mortality, 9% reoperation, and 21% complication rates were reported. Spinal stenosis was treated in relatively older children (mean age 13 ± 3 years) with laminectomy (23%), as well as with instrumented fusion (73%) for neurogenic claudication (59%), back pain (15%), and sciatica (8%). Although 95% of patients had symptom resolution after surgery, 17% reported complications and 18% required reoperation. Of the hydrocephalus patients (mean age 56 ± 103 months), half were treated with endoscopic third ventriculostomy (ETV) and half had a shunt placed for progressive ventriculomegaly (66%), headaches (32%), and delayed cognitive development (4%). The shunted patients had a 3% mortality rate and an average of 1.5 shunt revisions per patient. None of the patients who underwent ETV as the primary procedure required a revision. CONCLUSIONS Neurosurgical intervention for pediatric achondroplasia conditions, including cervicomedullary compression, spinal stenosis, and hydrocephalus, is associated with high recovery rates and good outcomes. However, complications and reoperations are common. Further studies with follow-up into adulthood are needed to evaluate the long-term outcomes.
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Affiliation(s)
| | - Albert M Isaacs
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michelle Stone
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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