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Dragun AJ, Fabiano AS, Weber T, Hall K, Bagley CA. Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: a single institution study. Spine J 2024; 24:1811-1816. [PMID: 38838854 DOI: 10.1016/j.spinee.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/24/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND CONTEXT With the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and postsurgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results. PURPOSE The goal of this study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates. STUDY DESIGN/SETTING A retrospective cohort study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness. PATIENT SAMPLE All patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (nonemergent admissions). OUTCOME MEASURES Presence of absence of postoperative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation. METHODS A database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance. RESULTS Significant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs 3.1%, respectively; p=.031), constipation (20.6% vs 11.4%, respectively; p=.001), and any complications (31.4% vs 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days. CONCLUSIONS Implementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.
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Affiliation(s)
- Anthony J Dragun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Alexander S Fabiano
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Theodore Weber
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Coskun E, Wellington IJ, Chaudhary C, Crea K, Cote MP, Rhee JM, Mallozzi S, Moss IL, Singh H. Clinical and radiologic outcomes of posterior column extension, pedicle subtraction, and vertebral column resection osteotomies in adult chin on chest deformity: A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100324. [PMID: 38765779 PMCID: PMC11101968 DOI: 10.1016/j.xnsj.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024]
Abstract
Background Chin-on-chest deformity is a rare and severely disabling condition characterized by kyphotic deformity in the cervicothoracic spine. To treat this deformity, various osteotomy techniques were described. Methods A comprehensive literature search of biomedical databases including MEDLINE (via PubMed), Scopus (via Elsevier), Embase (via Elsevier), and Cochrane Library in English from 1/1/1990 to 3/31/2022 was conducted using a combination of text and Medical Subject Headings (MeSH). Results The final analysis included 16 studies. All the studies were assigned a level of evidence of four. Except for two articles, all of the articles were non-comparative studies. A total of 288 patients were included in this review. Of the 288 patients, 107 underwent posterior column extension osteotomy (PCEO), 108 underwent pedicle subtraction osteotomy (PSO), and 33 underwent vertebral column resection osteotomy (VCRO). The most common osteotomy level in fifteen of the studies was C7/T1. The studies included in this review described several techniques for cervical sagittal balance correction. The range of preoperative and postoperative visual analogue scale (VAS) scores was 5.5-8.6 to 1.7-4.91, respectively. The range of preoperative and postoperative neck disability index (NDI) was 34.2-65.4 to 22.1-51.3, respectively. The most common complications were upper extremity paresthesia and hand numbness through the C8 dermatome distribution. Conclusions Corrective osteotomies provide satisfactory results in patients with chin-on-chest deformity; however, the quality of the included studies limits the evidence.
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Affiliation(s)
- Ergin Coskun
- Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202, United States
| | - Ian J. Wellington
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Chirag Chaudhary
- Insight Surgical Hospital, 21230 Dequindre Rd Warren, MI 4809, United States
| | - Kathleen Crea
- Lyman Maynard Stowe Library, UConn Health, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Mark P. Cote
- Massachusetts General Brigham Sports Medicine, Harvard Medical School, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - John M. Rhee
- Department of Orthopedic Surgery, Emory Spine Center, Emory University, 59 Executive Park South, Atlanta, GA 30327, United States
| | - Scott Mallozzi
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Isaac L. Moss
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Hardeep Singh
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
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Kalavacherla S, Stone LE, McCann CP, Saripella M, Pham MH. A systematic review of pseudarthrosis and reoperation rates in minimally invasive adult spinal deformity correction. World Neurosurg X 2024; 22:100282. [PMID: 38444873 PMCID: PMC10914570 DOI: 10.1016/j.wnsx.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Background/objective The recent development of minimally invasive surgical techniques (MIS) has made possible the correction of adult spinal deformity (ASD) with less blood loss and shorter hospital stays. However, minimally invasive placement of pedicle screws at the proximal level of the construct can increase pseudarthrosis risk, leading to implant failure, kyphosis, and reoperations. We aggregate existing literature to describe pseudarthrosis rates at the proximal thoracic or thoracolumbar junction in MIS and subsequent reoperation rates. Methods After a three-tied search strategy in PubMed, we identified 9 articles for study inclusion, describing outcomes from MIS correction of ASD, pseudarthrosis as complication, and surgery on 4+ levels. Baseline patient characteristics and combined rates of pseudarthrosis and reoperation were calculated. Results A total of 482 patients were studied with an average [range] age of 65.5 [60.4,72], 6.3 [4.4,11] levels fused per patient, follow-up time of 28.3 [12,39] months, and 64.8% females. Pseudarthrosis was reported in 28 of 482 pooled patients (5.8%) of which 15 of 374 pooled patients (4.0%) ultimately underwent a reoperation for pseudarthrosis. Post-operative characteristics included an estimated blood loss (EBL) of 527.1 [241,1466] mL, operating time of 297.9 [183,475] minutes, and length of stay of 7.7 [5,10] days. Among the papers comparing MIS to open surgery, all reported a significantly lower EBL in patients treated with MIS. Conclusion This analysis demonstrate a measurable pseudarthrosis risk when using MIS to treat ASD, overwhelming requiring reoperation. The benefits of MIS must be considered against the drawbacks of pseudarthrosis when determining ASD management.
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Affiliation(s)
| | - Lauren E. Stone
- Department of Neurological Surgery, University of California San Diego, La Jolla, CA, USA
| | - Carson P. McCann
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Megana Saripella
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Martin H. Pham
- Department of Neurological Surgery, University of California San Diego, La Jolla, CA, USA
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Quarto E, Zanirato A, Vitali F, Spatuzzi M, Bourret S, Le Huec JC, Formica M. Adult spinal deformity correction surgery using age-adjusted alignment thresholds: clinical outcomes and mechanical complication rates. A systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:553-562. [PMID: 37740115 DOI: 10.1007/s00586-023-07949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Adult spinal deformity (ASD) surgery gives good clinical outcomes but has a high rate of mechanical complications (MC). In 2016, Lafage described the age-adjusted alignment thresholds (AAAT) to adapt the correction in relation to patient's age proposing less aggressive corrections for the elderly population. The aim of this review was to clarify the effectiveness of AAAT to achieve good health-related quality of life (HRQoL) and their relationship with post-operative MC. MATERIALS AND METHODS We performed a review of the literature, including articles reporting data on post-operative HRQoL and MC rates in relation to the AAAT. Data were stratified according to whether they matched the AAAT, dividing the population in undercorrected (U), matched (M) and overcorrected (O). The quality of the included studies was assessed using the GRADE and MINORS systems. RESULTS Six articles reporting data from 1,825 patients were included. The different categories (U, M and O) had homogeneous pre-operative sagittal parameters (p > 0.05) that became statistically different after surgeries (p < 0.05). Proximal junctional kyphosis (PJK) was more frequent in the O group compared to U (p = 0.05). Post-operative HRQoL parameters were similar in the 3 groups (p > 0.05). The quality of the included studies was generally low with a high bias risk. CONCLUSION The results extrapolated from this review are interesting, as for the same HRQoL the U group had a lower MC rate. Unfortunately, the results are inconsistent, mainly because of the low quality of the included studies and the lack of reporting of some important patient- and surgery-related factors.
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Affiliation(s)
- E Quarto
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Spatuzzi
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
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Compagnone D, Mandelli F, Ponzo M, Langella F, Cecchinato R, Damilano M, Redaelli A, Peretti GM, Vanni D, Berjano P. Complications in endoscopic spine surgery: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:401-408. [PMID: 37587257 DOI: 10.1007/s00586-023-07891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. METHODS This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. RESULTS A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. CONCLUSION The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Matteo Ponzo
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | - Giuseppe Maria Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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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] [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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Kim YH, Ha KY, Park HY, Ko MS, Ko YI, Sin KJ, Kim SI. Junctional Failures at Both Ends After Long Fusion Arthrodesis Stopping at L5: Incidences and Risk Factors. World Neurosurg 2023; 180:e288-e295. [PMID: 37748733 DOI: 10.1016/j.wneu.2023.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Junctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal junctional failure (PJF) and distal junctional failure (DJF) after long lumbar instrumented fusion stopping at L5 for adult spinal deformity. METHODS Sixty-three patients who underwent long fusion surgery stopping at L5 with a minimum follow-up of 3 years were reviewed retrospectively. PJF and DJF were defined as newly developed back pain and/or radiculopathy with corresponding radiographic failures. The incidence and risk factors of each junctional failure were analyzed using a log-rank test and Cox proportional hazards model. RESULTS Twelve men and 51 women were included in our study. Their mean age was 68.5 ± 7.0 years and the mean follow-up period was 84.5 ± 45.3 months. PJF and DJF occurred in 17 (27%) and 16 patients (25.4%), respectively. PJF and DJF developed at median durations of 32.1 months and 13.3 months, respectively, showing no significant difference between the two. Three patients presented with both PJF and DJF. Risk factors for PJF included lower body mass index, higher preoperative lumbar lordosis, and higher postoperative sagittal vertical axis (SVA) (hazard ratio, 0.570, 1.055, and 1.040, respectively). For DJF, higher preoperative SVA was an independent risk factor (hazard ratio, 1.010). CONCLUSIONS After long fusion surgery stopping at L5, PJF and DJF occurred at similar rates. Lower body mass index, higher preoperative lumbar lordosis, and higher postoperative SVA were risk factors for PJF. Higher preoperative SVA was an independent risk factor for DJF.
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Affiliation(s)
- Young-Hoon Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Kyung-Hee University Hospital at Gangdong, Seoul, South Korea
| | - Hyung-Youl Park
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Myung-Sup Ko
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Il Ko
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Jun Sin
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Il Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Martín Benlloch A, Bolós Ten L, Morales Codina AM. [Translated article] Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S560-S575. [PMID: 37774916 DOI: 10.1016/j.recot.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients' quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilisation techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimise outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.
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Affiliation(s)
- A Martín Benlloch
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, Spain; Departamento de Cirugía, Universidad de Valencia, Valencia, Spain.
| | - L Bolós Ten
- Unidad de Columna A. Martín, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain
| | - A M Morales Codina
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, Spain
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Martín Benlloch A, Bolós Ten L, Morales Codina AM. Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:560-575. [PMID: 37689353 DOI: 10.1016/j.recot.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open
Abstract
En bloc resection of vertebral metastases has been the subject of study in medical literature due to its impact on patients' quality of life and effectiveness in local disease control. This bibliographic analysis examines the findings and perspectives of published studies concerning en bloc resection of oligometastases in the spine. The technique, which involves the complete removal of the tumour along with a portion of the surrounding bone, has been shown to improve local tumour control, reduce recurrence, and potentially prolong patient survival compared to conventional decompression and stabilization techniques. However, en bloc resection also presents risks and complications, such as surgical morbidity and extended recovery time. Appropriate patient selection, preoperative planning, and a multidisciplinary approach are essential to optimize outcomes. As new techniques and advances in adjuvant treatment develop, en bloc resection of oligometastases in the spine remains an area of interest in oncological research.
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Affiliation(s)
- A Martín Benlloch
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, España; Departamento de Cirugía, Universidad de Valencia, Valencia, España.
| | - L Bolós Ten
- Unidad de Columna A. Martín, Hospital Vithas Valencia 9 de Octubre, Valencia, España
| | - A M Morales Codina
- Unidad de Patología Compleja y Tumoral del Adulto, Hospital Universitario Dr. Peset, Valencia, España
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Shigematsu H, Ando M, Kobayashi K, Yoshida G, Funaba M, Morito S, Takahashi M, Ushirozako H, Kawabata S, Yamada K, Kanchiku T, Fujiwara Y, Taniguchi S, Iwasaki H, Tadokoro N, Wada K, Yamamoto N, Yasuda A, Hashimoto J, Tani T, Ando K, Machino M, Takatani T, Matsuyama Y, Imagama S. Efficacy of D-Wave Monitoring Combined With the Transcranial Motor-Evoked Potentials in High-Risk Spinal Surgery: A Retrospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Global Spine J 2023; 13:2387-2395. [PMID: 35343273 PMCID: PMC10538305 DOI: 10.1177/21925682221084649] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter cohort study. OBJECTIVES We aimed to clarify the efficacy of multimodal intraoperative neuromonitoring (IONM), especially in transcranial electrical stimulation of motor-evoked potentials (TES-MEPs) with spinal cord-evoked potentials after transcranial stimulation of the brain (D-wave) in the detection of reversible spinal cord injury in high-risk spinal surgery. METHODS We reviewed 1310 patients who underwent TES-MEPs during spinal surgery at 14 spine centers. We compared the monitoring results of TES-MEPs with D-wave vs TES-MEPs without D-wave in high-risk spinal surgery. RESULTS There were 40 cases that used TES-MEPs with D-wave and 1270 cases that used TES-MEPs without D-wave. Before patients were matched, there were significant differences between groups in terms of sex and spinal disease category. Although there was no significant difference in the rescue rate between TES-MEPs with D-wave (2.0%) and TES-MEPs (2.5%), the false-positivity rate was significantly lower (0%) in the TES-MEPs-with-D-wave group. Using a one-to-one propensity score-matched analysis, 40 pairs of patients from the two groups were selected. Baseline characteristics did not significantly differ between the matched groups. In the score-matched analysis, one case (2.5%) in both groups was a case of rescue (P = 1), five (12.5%) cases in the TES-MEPs group were false positives, and there were no false positives in the TES-MEPs-with-D-wave group (P = .02). CONCLUSIONS TES-MEPs with D-wave in high-risk spine surgeries did not affect rescue case rates. However, it helped reduce the false-positivity rate.
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Affiliation(s)
- Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Shinji Morito
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | | | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei Yamada
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Nobuaki Tadokoro
- Department of Orthopedic Surgery, Kochi University, Kochi, Japan
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoya Yamamoto
- Department of Orthopedic Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Defense Medical College Hospital, Saitama, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshikazu Tani
- Department of Orthopedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Pascucci S, Langella F, Franzò M, Tesse MG, Ciminello E, Biondi A, Carrani E, Sampaolo L, Zanoli G, Berjano P, Torre M. National spine surgery registries' characteristics and aims: globally accepted standards have yet to be met. Results of a scoping review and a complementary survey. J Orthop Traumatol 2023; 24:49. [PMID: 37715871 PMCID: PMC10505129 DOI: 10.1186/s10195-023-00732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Surgery involving implantable devices is widely used to solve several health issues. National registries are essential tools for implantable device surveillance and vigilance. In 2017, the European Union encouraged Member States to establish "registries and databanks for specific types of devices" to evaluate device safety and performance and ensure their traceability. Spine-implantable devices significantly impact patient safety and public health; spine registries might help improve surgical outcomes. This study aimed to map existing national spine surgery registries and highlight their features and organisational standards to provide an essential reference for establishing other national registries. METHODS A scoping search was performed using the Embase, PubMed/Medline, Scopus, and Web of Science databases for the terms "registry", "register", "implantable", and all terms and synonyms related to spinal diseases and national registries in publications from January 2000 to December 2020. This search was later updated and finalised through a web search and an ad hoc survey to collect further detailed information. RESULTS Sixty-two peer-reviewed articles were included, which were related to seven national spine registries, six of which were currently active. Three additional active national registries were found through the web search. The nine selected national registries were set up between 1998 and 2021. They collect data on the procedure and use patient-reported outcome measures (PROMs) for the follow-up. CONCLUSION Our study identified nine currently active national spine surgery registries. However, globally accepted standards for developing a national registry of spine surgery are yet to be established. Therefore, an international effort to increase result comparability across registries is highly advisable. We hope the recent initiative from the Orthopaedic Data Evaluation Panel (ODEP) to establish an international collaboration will meet these needs.
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Affiliation(s)
- Simona Pascucci
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
- Department of Mechanical and Aerospace Engineering, La Sapienza University of Rome, Rome, Italy
| | | | - Michela Franzò
- Department of Medico-Surgical Sciences and Biotechnologies, Rome, Italy
| | - Marco Giovanni Tesse
- Orthopaedics Section, Department of Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, AOU Consorziale Policlinico, 70124, Bari, Italy
| | - Enrico Ciminello
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Alessia Biondi
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Eugenio Carrani
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Letizia Sampaolo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | | | - Marina Torre
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
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12
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Lovecchio F, Shahi P, Patel A, Qureshi S. Single-position Minimally Invasive Surgery for Correction of Adult Spinal Deformity. J Am Acad Orthop Surg 2023; 31:e590-e600. [PMID: 37162446 DOI: 10.5435/jaaos-d-22-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023] Open
Abstract
Minimally invasive adult spinal deformity (MIS ASD) surgery may offer benefits over conventional techniques in select circumstances. The success of the procedure is based on proper patient selection, restoring adequate alignment, and optimizing fusion. In the past, MIS techniques were limited because of the need to reposition the patient-a source of increased surgical time and potentially patient risk. New developments now allow for single-position, MIS correction of adult deformity. Additional research will be needed to determine the ideal patient for minimally invasive adult spinal deformity surgery and whether prone or lateral single-position confers the best outcomes.
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Affiliation(s)
- Francis Lovecchio
- From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Lovecchio, Shahi, and Qureshi) and the Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL (Patel)
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13
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Montanari S, Griffoni C, Cristofolini L, Girolami M, Gasbarrini A, Barbanti Bròdano G. Correlation Between Sagittal Balance and Mechanical Distal Junctional Failure in Degenerative Pathology of the Spine: A Retrospective Analysis. Global Spine J 2023:21925682231195954. [PMID: 37562976 DOI: 10.1177/21925682231195954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to investigate the failure of the caudal end of lumbar posterior fixation in terms of pre-operative and post-operative spinopelvic parameters, correction performed, demographic and clinical data. METHODS The lumbar, thoraco-lumbar and lumbo-sacral posterior fixations performed with pedicle screws and rods in 2017-2019 were retrospectively analyzed. As 81% failures occurred within 4 years, an observational period of 4 years was chosen. The revision surgeries due to the failure in the caudal end were collected in the junctional group. Fixations which have not failed were gathered in the control group. The main spinopelvic parameters were measured for each patient on standing lateral radiographs with the software Surgimap. Demographic and clinical data were extracted for both groups. RESULTS Among the 457 patients who met the inclusion criteria, the junctional group included 101 patients, who required a revision surgery. The control group collected 356 primary fixations. The two most common causes of revision surgeries were screws pullout (57 cases) and rod breakage (53 cases). SVA, PT, LL, PI-LL and TPA differed significantly between the two groups (P = .021 for LL, P < .0001 for all the others). The interaction between the two groups and the pre-operative and post-operative conditions was significant for PT, SS, LL, TK, PI-LL and TPA (P < .005). Sex and BMI did not affect the failure onset. CONCLUSIONS Mechanical failure is more likely to occur in patients older than 40 years with a thoraco-lumbar fixation where PT, PI-LL and TPA were not properly restored.
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Affiliation(s)
- Sara Montanari
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Cristiana Griffoni
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Marco Girolami
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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14
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Babu JM, Wang KY, Jami M, Durand WM, Neuman BJ, Kebaish KM. Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy. Clin Spine Surg 2023; 36:190-194. [PMID: 37264520 DOI: 10.1097/bsd.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/25/2023] [Indexed: 06/03/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity. SUMMARY OF BACKGROUND DATA Sarcopenia is linked to morbidity and mortality in several orthopedic procedures. Data concerning sarcopenia in ASD surgery is limited, particularly with respect to complex techniques performed such as PSO. With the high surgical burden of PSOs, appropriate patient selection is critical for minimizing complications. METHODS We identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with spinal fusion ≥5 levels at a tertiary care center from 2005 to 2014. Sarcopenia was assessed by the psoas-lumbar vertebral index (PLVI). Using stratum-specific likelihood ratio analysis, patients were separated into 3 sarcopenia groups by complication risk. The primary outcome measure was any 2-year complication. Secondary outcome measures included intraoperative blood loss and length of stay. RESULTS The mean PLVI was 0.84±0.28, with 47% of patients having complications. Patients with a complication had a 27% lower PLVI on average than those without complications (0.76 vs. 0.91, P=0.021). Stratum-specific likelihood ratio analysis produced 3 complication categories: 32% complication rate for PLVI ≥ 0.81; 61% for PLVI 0.60-0.80; and 69% for PLVI < 0.60. Relative to patients with PLVI ≥ 0.81, those with PLVI 0.60-0.80 and PLVI < 0.60 had 3.2× and 4.3× greater odds of developing a complication (P<0.05). For individual complications, patients with PLVI < 1.0 had a significantly higher risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), while patients with PLVI < 0.8 had a significantly higher risk of wound infection (12% vs. 0%, P=0.028) and dural tear (14% vs. 0%, P=0.019). There were no significant associations between sarcopenia, intraoperative blood loss, and length of stay. CONCLUSIONS The increasing severity of sarcopenia is associated with a significantly and incrementally increased risk of complications following ASD surgery that require PSO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jacob M Babu
- Illinois Bone & Joint Institute, 720 Florsheim Drive, Libertyville, IL
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Meghana Jami
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
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Bayoglu R, Witt JP, Chatain GP, Okonkwo DO, Kanter AS, Hamilton DK, Puccio LM, Alan N, Ignasiak D. Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment. Spine (Phila Pa 1976) 2023; 48:E107-E115. [PMID: 36988224 PMCID: PMC10035656 DOI: 10.1097/brs.0000000000004555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers. OBJECTIVE This study aimed to determine the validity of a computational framework for predicting postoperative patient posture based on preoperative imaging and surgical data in a large clinical sample. SUMMARY OF BACKGROUND DATA Short-term and long-term studies on thoracolumbar fusion patients have discussed that a preoperative predictive model would benefit surgical planning and improve patient outcomes. Clinical studies have shown that postoperative alignment changes at the pelvis and intact spine levels may negatively affect postural balance and quality of life. However, it remains challenging to predict such changes preoperatively because of confounding surgical and patient factors. MATERIALS AND METHODS Patient-specific musculoskeletal models incorporated weight, height, body mass index, age, pathology-associated muscle strength, preoperative sagittal alignment, and surgical treatment details. The sagittal alignment parameters predicted by the simulations were compared with those observed radiographically at a minimum of three months after surgery. RESULTS Pearson correlation coefficients ranged from r=0.86 to 0.95, and mean errors ranged from 4.1° to 5.6°. The predictive accuracies for postoperative spinopelvic malalignment (pelvic incidence minus lumbar lordosis>10°) and sagittal imbalance parameters (TPA>14°, T9PA>7.4°, or LPA>7.2°) were between 81% and 94%. Patients treated with long fusion (greater than five segments) had relatively lower prediction errors for lumbar lordosis and spinopelvic mismatch than those in the local and short groups. CONCLUSIONS The overall model performance with long constructs was superior to those of the local (one to two segments) and short (three to four segments) fusion cases. The clinical framework is a promising tool in development to enhance clinical judgment and to help design treatment strategies for predictable surgical outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Jens-Peter Witt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Grégoire P. Chatain
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam S. Kanter
- Hoag Specialty Clinic, Hoag Neurosciences Institute, Newport Beach, CA
| | - D. Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lauren M. Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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16
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Henson P, Shuman WH, Li AY, Ali M, Kalagara R, Hrabarchuk E, Schupper AJ, Steinberger J, Gal JS, Choudhri TF. Seasonal Effects on Postoperative Complications After Spinal Surgery: A National Database Analysis. World Neurosurg 2023; 170:e455-e466. [PMID: 36375802 DOI: 10.1016/j.wneu.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the role of seasonality on postoperative complications after spinal surgery. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018. Current Procedural Terminology codes were used to identify the following procedures: posterior cervical decompression and fusion, cervical laminoplasty, posterior lumbar fusion, lumbar laminectomy, and spinal deformity surgery. The database was queried for deep vein thrombosis (DVT), pulmonary embolism, pneumonia, sepsis, septic shock, Clostridium difficile infection, stroke, cardiac arrest, myocardial infarction, urinary tract infection (UTI), and early unplanned hospital readmission (readmission). Warm season was defined as April-September, whereas cold season was defined as October-March. Statistical analysis included computing overall complication rates and comparison between seasons using univariate analysis and multivariable logistic regression. RESULTS A total of 208,291 individuals underwent spinal surgery from 2011 to 2018. There was a statistically significant increase in UTI (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.07-1.26; P = 0.0002) and readmission (OR, 1.06; 95% CI, 1.02-1.11, P = 0.007) in the warm season compared with the cold season. An investigation into the July effect showed increases in DVT (OR, 1.24; 95% CI, 1.03-1.48; P = 0.020) and thromboembolic events (OR 1.17; 95% CI, 1.01-1.35; P = 0.032) in July-September compared with the preceding 3 months. CONCLUSIONS The results showed a higher incidence of UTI and readmission among spine surgery patients in the warm season and a higher incidence of DVT and thromboembolic events from July to September. In both cases, the effect of seasonality is statistically significant, but the absolute difference is small and may not suggest policy changes.
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Affiliation(s)
- Philip Henson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA.
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Alex J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jonathan S Gal
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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17
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Ricciardi L, Piazza A, Capobianco M, Della Pepa GM, Miscusi M, Raco A, Scerrati A, Somma T, Lofrese G, Sturiale CL. Lumbar interbody fusion using oblique (OLIF) and lateral (LLIF) approaches for degenerative spine disorders: a meta-analysis of the comparative studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1-7. [PMID: 34825987 DOI: 10.1007/s00590-021-03172-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels. METHODS The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications. RESULTS After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group. CONCLUSIONS The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
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Affiliation(s)
- Luca Ricciardi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Amedeo Piazza
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Mattia Capobianco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | | | - Massimo Miscusi
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Antonino Raco
- Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giorgio Lofrese
- Division of Neurosurgery, Ospedale Bufalini, Cesena, Italy. .,Dipartimento Neuroscienze, Unità Operativa Complessa di Neurochirurgia, Ospedale "M.Bufalini", Viale Ghirotti 286, 47521, Cesena, Italy.
| | - Carmelo Lucio Sturiale
- Operative Unit of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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18
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Kodama J, Wilkinson KJ, Otsuru S. Nutrient metabolism of the nucleus pulposus: A literature review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 13:100191. [PMID: 36590450 PMCID: PMC9801222 DOI: 10.1016/j.xnsj.2022.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Cells take in, consume, and synthesize nutrients for numerous physiological functions. This includes not only energy production but also macromolecule biosynthesis, which will further influence cellular signaling, redox homeostasis, and cell fate commitment. Therefore, alteration in cellular nutrient metabolism is associated with pathological conditions. Intervertebral discs, particularly the nucleus pulposus (NP), are avascular and exhibit unique metabolic preferences. Clinical and preclinical studies have indicated a correlation between intervertebral degeneration (IDD) and systemic metabolic diseases such as diabetes, obesity, and dyslipidemia. However, a lack of understanding of the nutrient metabolism of NP cells is masking the underlying mechanism. Indeed, although previous studies indicated that glucose metabolism is essential for NP cells, the downstream metabolic pathways remain unknown, and the potential role of other nutrients, like amino acids and lipids, is understudied. In this literature review, we summarize the current understanding of nutrient metabolism in NP cells and discuss other potential metabolic pathways by referring to a human NP transcriptomic dataset deposited to the Gene Expression Omnibus, which can provide us hints for future studies of nutrient metabolism in NP cells and novel therapies for IDD.
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Affiliation(s)
- Joe Kodama
- Corresponding authors at: 670 W Baltimore St. HSFIII 7173, Baltimore, MD 21201, USA.
| | | | - Satoru Otsuru
- Corresponding authors at: 670 W Baltimore St. HSFIII 7173, Baltimore, MD 21201, USA.
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19
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Masuda S, Suzuki A, Takahashi S, Tamai K, Nakamura H. Delayed aortic injury after thoracic corrective osteotomy: a case report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3703-3707. [PMID: 34609615 DOI: 10.1007/s00586-021-07014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present a case of delayed aortic perforation due to a nondisplaced fracture of the 9th rib after vertebral osteotomy for degenerative kyphoscoliosis in patients with osteoporosis. METHODS A 78-year-old female patient with osteoporosis had undergone T9-iliac correction surgery for degenerative kyphoscoliosis. After 2 years, the patient underwent T10 pedicle subtraction osteotomy for a T10 vertebral fracture and progression of kyphosis. Postoperatively, the patient had been doing well for 3 weeks; however, just before the day of discharge, she died following a cardiopulmonary arrest. An autopsy was performed with the consent of her family. RESULTS Autopsy revealed a large amount of blood and a clot in the left thoracic cavity. Aortic perforation was found just in front of a nondisplaced fracture of the left 9th rib. CONCLUSION This report describes a new critical complication after spinal correction surgery. Even without pedicle screw malposition, aortic injuries can happen to patients with osteoporosis after corrective osteotomy for degenerative kyphoscoliosis due to positional change of aorta and fragility of the ribs. The spine surgeon should be aware of this type of complication, and rib fractures around the aorta after vertebral osteotomy should not be neglected even when there is no displacement.
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Affiliation(s)
- Sho Masuda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan.
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan
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20
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McDonnell JM, Evans SR, Ahern DP, Cunniffe G, Kepler C, Vaccaro A, Kaye ID, Morrissey PB, Wagner SC, Sebastian A, Butler JS. Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3654-3661. [PMID: 36178547 DOI: 10.1007/s00586-022-07396-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/02/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD. METHODS A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and compared to those without DJF. Survival analyses were performed using univariate logistic regression to identify variables with a p value < 0.05 for inclusion in multivariate analysis. Spearman's correlations were performed where applicable. RESULTS One hundred two patients were identified. 41 (40.2%) suffered DJF in the postoperative period, with rod fracture being the most common sign of DJF (13/65; 20.0%). Mean time to failure was 32.4 months. On univariate analysis, pedicle subtraction osteotomy (p = 0.03), transforaminal lumbar interbody fusion (p < 0.001), pre-op LL (p < 0.01), pre-op SVA (p < 0.01), pre-op SS (p = 0.02), postop LL (p = 0.03), postop SVA (p = 0.01), postop PI/LL (p < 0.001), LL correction (p < 0.001), SVA correction (p < 0.001), PT correction (p = 0.03), PI/LL correction (p < 0.001), SS correction (p = 0.03) all proved significant. On multivariate analysis, pedicle subtraction osteotomy (OR 27.3; p = 0.03), postop SVA (p < 0.01) and LL correction (p = 0.02) remained statistically significant as independent risk factors for DJF. CONCLUSION Recently, DJF has received recognition as its own entity due to a notable postoperative incidence. Few studies to date have evaluated risk factors for DJF. The results of our study highlight that pedicle subtraction osteotomy, poor correction of lumbar lordosis, and sagittal vertical axis are significantly associated with postoperative occurrence of DJF.
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Affiliation(s)
- Jake M McDonnell
- Royal College of Surgeons in Ireland, Dublin, Ireland. .,National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Shane R Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christopher Kepler
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Alexander Vaccaro
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ian D Kaye
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Washington, DC, USA
| | | | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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21
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Quarto E, Zanirato A, Pellegrini M, Vaggi S, Vitali F, Bourret S, Le Huec JC, Formica M. GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3286-3295. [PMID: 36153789 DOI: 10.1007/s00586-022-07386-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In 2017, the GAP score was proposed as a tool to reduce mechanical complications (MC) in adult spinal deformity (ASD) surgery: the reported MC rate for the GAP proportioned category was only 6%, which is clearly lower to the MC rate reported in the literature. The aim of this study is to analyse if the most recent literature confirms the promising results of the original article. MATERIALS AND METHODS Using the PRISMA flow chart, we reviewed the literature to analyse GAP score capacity in predicting MC occurrence. We included articles clearly reporting ASD surgery MC stratified by GAP categories and the score's overall capacity to predict MC using the area under the curve (AUC). The quality of the included studies was evaluated using GRADE and MINORS systems. RESULTS Eleven retrospective articles (1,517 patients in total) were included. The MC distribution per GAP category was as follows: GAP-P, 32.8%; GAP-MD, 42.3%; GAP-SD, 55.4%. No statistically significant difference was observed between the different categories using the Kruskal-Wallis test (p = 0.08) and the two-by-two Pearson-Chi square test (P Vs MD, p = 0.300; P Vs SD, p = 0.275; MD Vs SD, p = 0.137). The global AUC was 0.68 ± 0.2 (moderate accuracy). The included studies were of poor quality according to the GRADE system and had a high risk of bias based on the MINORS criteria. CONCLUSION The actual literature does not corroborate the excellent results reported by the original GAP score article. Further prospective studies, possibly stratified by type of MC and type of surgery, are necessary to validate this score.
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Affiliation(s)
- E Quarto
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Pellegrini
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Vaggi
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
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22
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Cecchinato R, Berjano P, Compagnone D, Langella F, Nervi A, Pezzi A, Mangiavini L, Lamartina C. Long spine fusions to the sacrum-pelvis are associated with greater post-operative proximal junctional kyphosis angle in sitting position. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3573-3579. [PMID: 36227365 DOI: 10.1007/s00586-022-07418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN A single-centre retrospective study. BACKGROUND AND PURPOSE Although adult patients spend most of their time in sitting positions, the assessment of spinopelvic parameters in adult deformity surgery is commonly performed in standing X-rays. Our study compares the standing and sitting sagittal alignment parameters in subjects who underwent thoracolumbar fusion. METHODS Patients who underwent corrective surgery for adult scoliosis with at least five instrumented vertebra were stratified according to the upper instrumented vertebra (UIV) and pelvic fixation. Group A:UIV proximal to T6 with pelvis fixation. B:UIV lower than T6 and pelvic fixation. Group C: thoracolumbar fusion without pelvic fixation. Post-operative spinopelvic sagittal parameters were measured in both standing and sitting X-rays. RESULTS A total of 51 patients were enrolled in the study (11:Males and 40:Females). The mean age was 52.3 ± 21.7y/o. The comparison of post-operative standing and sitting X-ray within the group A and B showed that a significant change was observed in terms of JA-Junctional Angle-(Group A 6.3 ± 4.3 vs. 8.1 ± 3.3, p value = 0.03) (Group B 8.5 ± 6.4 vs. 10.9 ± 6.4, p value = 0.02). Group C showed statistically significant difference in terms of PT (15.6 ± 11.2 vs. 19.3 ± 9.2, p value = 0.04), AVA-Acetabular Version Angle-(41.1 ± 5.9 vs. 48.3 ± 6.6, p value < 0.01) and LL (- 51.3 ± 16.0 vs. - 42.6 ± 10.7, p value < 0.01). CONCLUSION In our series, the post-operative sagittal alignment showed peculiar behaviours and adaptations in sitting position, depending on the length and the site of the instrumented area. If the pelvis is included, the JA tends to significantly increase in sitting position. These findings can improve the knowledge of pathologies as proximal junctional kyphosis or specific cases of anterior hip impingement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | | | | | - Andrea Nervi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Pezzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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23
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Lainé G, Le Huec JC, Blondel B, Fuentes S, Fiere V, Parent H, Lucas F, Roussouly P, Tassa O, Bravant E, Berthiller J, Barrey CY. Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3673-3686. [PMID: 36192454 DOI: 10.1007/s00586-022-07410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/14/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. METHODS The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed. RESULTS Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32-4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08-2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29-0.89)] (p = 0.02). CONCLUSION Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.
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Affiliation(s)
- G Lainé
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
| | - J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux University, Bordeaux, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - V Fiere
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - H Parent
- Clinique Saint Léonard, Trélazé, France
| | - F Lucas
- Hopital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - P Roussouly
- Centre Médico-Chirurgical Des Massues, Croix Rouge, Lyon, France
| | - O Tassa
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - E Bravant
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
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24
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Management of severe adult spinal deformity with circumferential minimally invasive surgical strategies without posterior column osteotomies: a 13-year experience. Spine Deform 2022; 10:1157-1168. [PMID: 35334105 DOI: 10.1007/s43390-022-00478-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 01/22/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the mid- to long-term clinical outcomes of circumferential minimally invasive surgery (CMIS) without posterior column osteotomies for severe adult spine deformity (ASD) correction. METHODS All patients with a minimum of 2-year follow-up undergoing staged CMIS correction of ASD from January 2007 to July 2018 were identified. All included patients had fusion of 3 or more interbody levels that spanned the L5-S1 junction. Only patients with severe deformity, Coronal Cobb > 50° or at least one SRS-Schwab ++ sagittal modifier (SVA > 95 mm, or PI-LL > 20, or PT > 30) were included. All complications were noted. RESULT 136 patients met inclusion criteria; mean age of patients was 63.6 years (21-85, SD 13.7). The mean follow-up was 82.8 months (24-159, SD 36.6). The mean number of levels fused was 7 (3-16, SD 3). A total of 40 (29.4%) major complications were noted at final follow-ups: 2 (1.4%) intra-operative, 12 (8.9%) peri-operative (≤ 6 weeks from index), 26 (19.1%) post-operative (> 6 weeks from index). There was a total of 53 (40.0%) minor complications. Seven (5.1%) patients who developed radiographic proximal junctional kyphosis. Three patients (2.2%) developed proximal junctional failure. There were 8 (5.9%) cases of pseudarthrosis. Five of these occurred in patients undergoing AxiaLIF. All patients experienced improvements in patient-perceived outcomes (VAS, TIS, ODI, and SRS-22) and radiographic parameters at last follow-up when compared to pre-op (p < 0.05). CONCLUSION Rates of complications with CMIS correction of severe ASD are lower than published rates of complications seen with open ASD correction. Specifically, the incidence of catastrophic complications is lower. Furthermore, CMIS is associated with significant improvements in clinical and functional outcomes, low rates of pseudarthrosis and proximal junctional kyphosis. Therefore, in the appropriately selected patient, CMIS may be an excellent alternative approach to addressing severe ASD.
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25
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Liu C, Hu F, Hu W, Zhang Z, Zheng G, Song K, Li F, Zhang X. Clinical Results of Utilizing the Satellite Rod Technique in Treating Ankylosing Spondylitis Kyphosis. Orthop Surg 2022; 14:2180-2187. [PMID: 35946438 PMCID: PMC9483082 DOI: 10.1111/os.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 12/01/2022] Open
Abstract
Objective According to the literature, there are no clinical reports documenting the use of the satellite rod technique in the treatment of ankylosing spondylitis kyphosis. The purpose of this retrospective study was to compare the clinical outcome of patients with ankylosing spondylitis kyphosis who adopted satellite rods versus those who did not. Methods Patients with ankylosing spondylitis kyphosis who underwent one or two‐level pedicle subtraction osteotomy (PSO) were reviewed, and total of 119 patients (112 males and seven females, average age 39.89 ± 6.61 years) were eligible and included in this present study. Anterior–posterior and lateral full‐length spine X‐ray films were performed preoperatively and at the two‐year follow‐up visit. Global kyphosis (GK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), and osteotomy angle (OA) were measured. The complications of every group of patients were collected. Pre‐ and postoperative health‐related quality of life instruments, including the Bath Ankylosing Spondylitis Functional Index (Basfi) and Scoliosis Research Society outcomes instrument‐22 (SRS‐22), were recorded. The patients were divided into three groups based on features of their osteotomy including PSO levels and whether the satellite rod technique was applied. Patients who underwent one‐level PSO without the satellite rod technique were categorized in the one‐level group. Patients who underwent one‐level PSO with the satellite rod technique were classified in the satellite rod group. Patients who underwent two‐level PSO without the satellite rod technique were included in the two‐level group. The paired sample t test was used to compare pre‐ and postoperative parameters. One‐way ANOVA was performed for multiple group comparisons. Results The average follow‐up time is 29.31 ± 3.66 months. The patients' GK were significantly improved from 46.84 ± 20.37 degree to 3.31 ± 15.09 degree. OS achieved through each osteotomy segment of one‐level group (39.78 ± 12.29 degree) and satellite rods group (42.23 ± 9.82 degree), was larger than that of two‐level group (34.73 ± 7.54 and 28.85 ± 7.26 degree). There was no significant difference between the one‐level group and the satellite rod group in achieving the OS. Thirteen patients experienced different complications (10.92%). Three patients experienced rod fracture in the one‐level group. There was no rod fracture or screw failure in the satellite rod group or the two‐level group. Conclusion The satellite rod technique is also recommended for patients who undergo PSO osteotomy to correct ankylosing spondylitis kyphosis deformities.
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Affiliation(s)
- Chao Liu
- Department of Orthopaedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Fanqi Hu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Wenhao Hu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Zhen Zhang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Guoquan Zheng
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Kai Song
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Fangcai Li
- Department of Orthopaedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xuesong Zhang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
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The Clinical Impact of Failing to Achieve Ideal Proportional Realignment in Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2022; 47:995-1002. [PMID: 35125457 DOI: 10.1097/brs.0000000000004337] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023]
Abstract
SUMMARY OF BACKGROUND DATA The impact of not achieving ideal realignment in the global alignment and proportion (GAP) score in adult spinal deformity (ASD) correction on clinical outcomes is understudied at present. OBJECTIVE To identify the clinical impact of failing to achieve GAP proportionality in ASD surgery. STUDY DESIGN Retrospective cohort. METHODS Operative ASD patients with fusion to S1/pelvis and with pre-(BL) and 2-year (2Y) data were included. Patients were assessed for matching their 6-week (6W) age-adjusted alignment goals. 1 Patients were stratified by age-adjusted match at 6W postoperatively (Matched) and 6W GAP proportionality (proportioned: GAP-P; moderately disproportioned: GAP-MD; severely disproportioned: GAP-SD). Groups were assessed for differences in demographics, surgical factors, radiographic parameters, and complications occurring by 2Y. Multivariable logistic regression was used to assess independent effects of not achieving GAP proportionality on postoperative outcomes for Matched and Unmatched patients. RESULTS Included: One hundred twenty three ASD patients. At baseline, 39.8% were GAP-SD, and 12.2% GAP-SD at 6W. Of 123 patients, 51.2% (n =63) had more than or equal to one match at 6W. GAP-SD rates did not differ by being Matched or Unmatched ( P = 0.945). GAP-SD/Unmatched patients had higher rates of reoperation, implant failure, and PJF by 2Y postop (all P <0.05). Regressions controlling for age at BL, levels fused, and CCI, revealed 6W GAP-SD/Unmatched patients had higher odds of reoperation (OR: 54 [3.2-899.9]; P =0.005), implant failure (OR: 6.9 [1.1-46.1]; P =0.045), and PJF (OR: 30.1 [1.4-662.6]; P =0.031). Compared to GAP-P or GAP-MD patients, GAP-SD/ Matched patients did not have higher rates of reoperation, implant failure, or junctional failure (all P >0.05). The regression results for both Matched and Unmatched cohorts were consistent when proportionality was substituted by the continuous GAP score. CONCLUSION In ASD patients who meet age-adjusted realignment goals, GAP proportionality does not significantly alter complication rates. However, GAP proportionality remains an important consideration in patients with sub-optimal age- adjusted alignment. In these cases, severe global disproportion is associated with higher rates of reoperation, implant failure, rod fracture, and junctional failure.
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Tsutsui S, Yamamoto E, Kozaki T, Murata A, Yamada H. Biomechanical study of rod stress in lumbopelvic fixation with lateral interbody fusion: an in vitro experimental study using synthetic bone models. J Neurosurg Spine 2022; 37:73-79. [PMID: 35171839 DOI: 10.3171/2021.11.spine21807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite improvements in surgical techniques and instruments, high rates of rod fracture following a long spinal fusion in the treatment of adult spinal deformity (ASD) remain a concern. Thus, an improved understanding of rod fracture may be valuable for better surgical planning. The authors aimed to investigate mechanical stress on posterior rods in lumbopelvic fixation for the treatment of ASD. METHODS Synthetic lumbopelvic bone models were instrumented with intervertebral cages, pedicle screws, S2-alar-iliac screws, and rods. The construct was then placed in a testing device, and compressive loads were applied. Subsequently, the strain on the rods was measured using strain gauges on the dorsal aspect of each rod. RESULTS When the models were instrumented using titanium alloy rods at 30° lumbar lordosis and with lateral interbody fusion cages, posterior rod strain was highest at the lowest segment (L5-S1) and significantly higher than that at the upper segment (L2-3) (p = 0.002). Changing the rod contour from 30° to 50° caused a 36% increase in strain at L5-S1 (p = 0.009). Changing the rod material from titanium alloy to cobalt-chromium caused a 140% increase in strain at L2-3 (p = 0.009) and a 28% decrease in strain at L5-S1 (p = 0.016). The rod strain at L5-S1 using a flat bender for contouring was 23% less than that obtained using a French bender (p = 0.016). CONCLUSIONS In lumbopelvic fixation in which currently available surgical techniques for ASD are used, the posterior rod strain was highest at the lumbosacral junction, and depended on the contour and material of the rods.
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Affiliation(s)
- Shunji Tsutsui
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Ei Yamamoto
- 2Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai University, Wakayama, Japan
| | - Takuhei Kozaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Akimasa Murata
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University; and
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Post-operative L5 radiculopathy after L5-S1 hyperlordotic anterior lumbar interbody fusion (HL-ALIF) is related to a greater increase of lordosis and smaller post-operative posterior disc height: results from a cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1640-1648. [PMID: 35597893 DOI: 10.1007/s00586-022-07256-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/10/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN A single-centre retrospective study. BACKGROUND AND PURPOSE This study aims to investigate the rate of L5 radiculopathy, to identify imaging features associated with the complication and to evaluate the clinical outcomes in adult spine deformity patients undergoing L5-S1 ALIF with hyperlordotic cages. METHODS Design: retrospective cohort study. A single-centre prospective database was queried to analyse patients undergoing hyperlordotic (HL) ALIF with posterior fusion to correct spinal deformity. Clinical status was evaluated by back and leg pain numeric rate scale and Oswestry Disability Index pre-operatively and at 3-, 6- and 12-month follow-up. Spinopelvic parameters, such as pelvic incidence, pelvic tilt, lumbar lordosis and L5-S1 lordosis, posterior disc height (PDH) and anterior disc height, were assessed pre-operatively and post-operatively on standardized full-spine standing EOS images. The sagittal foraminal area was measured pre- and post-operatively on a CT scan. RESULTS Thirty-nine patients with a mean age of 63.2 ± 8.6 years underwent HL-ALIF from January 2016 to December 2019. Seven of them developed post-operative root pain (5) or weakness (2) (Group A), while thirty-two did not (Group B). Root impairment was associated with greater segmental correction magnitude, 26° ± 11.1 in Group A versus 15.1° ± 9.9 in Group B (p < 0.05), and to smaller post-operative PDH, 5.9 mm ± 2.7 in Group A versus 8.3 mm ± 2.6 (p < 0.05). CONCLUSIONS Post-operative root problems were observed in 17.9% of patients undergoing HL-ALIF for adult spine deformity. L5 radiculopathy was associated with larger sagittal angular corrections and smaller post-operative posterior disc height. One patient (2.6%) needed L5 root decompression. At 12 months of follow-up, results were equivalent between groups. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Taliaferro K, Rao A, Theologis AA, Cummins D, Callahan M, Berven SH. Rates and risk factors associated with 30- and 90-day readmissions and reoperations after spinal fusions for adult lumbar degenerative pathology and spinal deformity. Spine Deform 2022; 10:625-637. [PMID: 34846718 DOI: 10.1007/s43390-021-00446-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Analyze state databases to determine variables associated with of short-term readmissions and reoperations following thoracolumbar spine fusions for degenerative pathology and spinal deformity. METHODS Retrospective study of State Inpatient Database (2005-13, CA, NE, NY, FL, NC, UT). INCLUSION CRITERIA age > 45 years, diagnosis of degenerative spinal deformity, ≥ 3 level posterolateral lumbar spine fusion. EXCLUSION CRITERIA revision surgery, cervical fusions, trauma, and cancer. Univariate and step-wise multivariate logistic regression analyses were performed to identify independent variables associated with of 30- and 90-day readmissions and reoperations. RESULTS 12,641 patients were included. All-cause 30- and 90-day readmission rates were 14.6% and 21.1%, respectively. 90-day readmissions were associated with: age > 80 (OR: 1.42), 8 + level fusions (OR: 1.19), hospital length of stay (LOS) > 7 days (OR: 1.43), obesity (OR: 1.29), morbid obesity (OR: 1.66), academic hospital (OR: 1.13), cancer history (OR:1.21), drug abuse (OR: 1.31), increased Charlson Comorbidity index (OR: 1.12), and depression (OR: 1.20). Private insurance (OR: 0.64) and lumbar-only fusions (OR: 0.87) were not associated with 90-day readmissions. All-cause 30- and 90-day reoperation rates were 1.8% and 4.2%, respectively. Variables associated with 90-day reoperations were 8 + level fusions (OR: 1.28), LOS > 7 days (OR: 1.43), drug abuse (OR: 1.68), osteoporosis (OR: 1.26), and depression (OR: 1.23). Circumferential fusion (OR: 0.58) and lumbar-only fusions (OR: 0.68) were not associated with 90-day reoperations. CONCLUSIONS 30- and 90-day readmission and reoperation rates in thoracolumbar fusions for adult degenerative pathology and spinal deformity may have been underreported in previously published smaller studies. Identification of modifiable risk factors is important for improving quality of care through preoperative optimization.
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Affiliation(s)
- Kevin Taliaferro
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Aditya Rao
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA
| | - Daniel Cummins
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA
| | - Matthew Callahan
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor Rm 321, San Francisco, CA, USA.
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Zaborovskii NS, Ptashnikov DA, Mikhailov DA, Smekalenkov OA, Masevnin SV, Diusenov DO, Kazantsev ND. Complications in spinal tumor surgery (review of literature). GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-92-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Combined anterior and posterior approaches are required in spinal tumor surgery and considered highly invasive. Anatomical and physiological features of the surgical intervention area should be taken into consideration as well. Thus, these criteria reflect the severity of intraoperative complications during the surgical treatment of spinal tumors. The authors reviewed the scientific literature on the frequency and nature of complications in surgical interventions for spinal tumors.The most significant risk factors for intraoperative complications have been considered, the main of which are: the proximity of the location of the main vessels and viscera, the development of postoperative liquorrhea, as well as surgical site infection. Based on the studied information, we presented the methods of prevention and surgical tactics options in complications.
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Affiliation(s)
- N. S. Zaborovskii
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden; Saint Petersburg University
| | - D. A. Ptashnikov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden; North-Western State Medical University named after I. I. Mechnikov
| | - D. A. Mikhailov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
| | - O. A. Smekalenkov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
| | - S. V. Masevnin
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
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The Influence of Baseline Clinical Status and Surgical Strategy on Early Good to Excellent Result in Spinal Lumbar Arthrodesis: A Machine Learning Approach. J Pers Med 2021; 11:jpm11121377. [PMID: 34945849 PMCID: PMC8705358 DOI: 10.3390/jpm11121377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
The study aims to create a preoperative model from baseline demographic and health-related quality of life scores (HRQOL) to predict a good to excellent early clinical outcome using a machine learning (ML) approach. A single spine surgery center retrospective review of prospectively collected data from January 2016 to December 2020 from the institutional registry (SpineREG) was performed. The inclusion criteria were age ≥ 18 years, both sexes, lumbar arthrodesis procedure, a complete follow up assessment (Oswestry Disability Index-ODI, SF-36 and COMI back) and the capability to read and understand the Italian language. A delta of improvement of the ODI higher than 12.7/100 was considered a "good early outcome". A combined target model of ODI (Δ ≥ 12.7/100), SF-36 PCS (Δ ≥ 6/100) and COMI back (Δ ≥ 2.2/10) was considered an "excellent early outcome". The performance of the ML models was evaluated in terms of sensitivity, i.e., True Positive Rate (TPR), specificity, i.e., True Negative Rate (TNR), accuracy and area under the receiver operating characteristic curve (AUC ROC). A total of 1243 patients were included in this study. The model for predicting ODI at 6 months' follow up showed a good balance between sensitivity (74.3%) and specificity (79.4%), while providing a good accuracy (75.8%) with ROC AUC = 0.842. The combined target model showed a sensitivity of 74.2% and specificity of 71.8%, with an accuracy of 72.8%, and an ROC AUC = 0.808. The results of our study suggest that a machine learning approach showed high performance in predicting early good to excellent clinical results.
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Artificial Intelligence in Adult Spinal Deformity. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 134:313-318. [PMID: 34862555 DOI: 10.1007/978-3-030-85292-4_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Artificial Intelligence is gaining traction in medicine for its ease of use and advancements in technology. This study evaluates the current literature on the use of artificial intelligence in adult spinal deformity.
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Weiss HR, Nan X, Potts MA. Is there an indication for surgery in patients with spinal deformities? - A critical appraisal. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1569. [PMID: 34859161 PMCID: PMC8603189 DOI: 10.4102/sajp.v77i2.1569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022] Open
Abstract
Background High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment. Objective The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities. Method A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann's disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome. Results No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery. Conclusions A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities. Clinical implications In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.
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Affiliation(s)
| | - Xiaofeng Nan
- Nan Xiaofeng's Spinal Orthopedic Workshop, Xi 'an, China
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Characteristics of Cases with Poor Transcranial Motor-evoked Potentials Baseline Waveform Derivation in Spine Surgery: A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Spine (Phila Pa 1976) 2021; 46:E1211-E1219. [PMID: 34714796 DOI: 10.1097/brs.0000000000004074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective multicenter study. OBJECTIVE The purpose of the study is to examine cases with poor baseline waveform derivation for all muscles in multichannel monitoring of transcranial motor-evoked potentials (Tc-MEPs) in spine surgery. SUMMARY OF BACKGROUND DATA Intraoperative neuromonitoring (IONM) is useful for identifying neurologic deterioration during spinal surgery. Tc-MEPs are widely used for IONM, but some cases have poor waveform derivation, even in multichannel Tc-MEP monitoring. METHODS The subjects were 3625 patients (mean age 60.1 years, range 4-95; 1886 females, 1739 males) who underwent Tc-MEP monitoring during spinal surgery at 16 spine centers between April 2017 and March 2020. Baseline Tc-MEPs were recorded from the deltoid, abductor pollicis brevis, adductor longus, quadriceps femoris, hamstrings, tibialis anterior, gastrocnemius, and abductor hallucis (AH) muscles after surgical exposure of the spine. RESULTS The 3625 cases included cervical, thoracic, and lumbar lesions (50%, 33% and 17%, respectively) and had preoperative motor status of no motor deficit, and motor deficit with manual muscle testing (MMT) ≥3 and MMT <3 (70%, 24% and 6%, respectively). High-risk surgery was performed in 1540 cases (43%). There were 73 cases with poor baseline waveform derivation (2%), and this was significantly associated with higher body weight, body mass index, thoracic lesions, motor deficit of MMT <3, high-risk surgery (42/1540 [2.7%] vs. 31/2085 [1.5%], P < 0.05), and surgery for ossification of the posterior longitudinal ligament (OPLL). Intraoperative waveform derivation occurred in 25 poor derivation cases (34%) and the AH had the highest rate. CONCLUSION The rate of poor baseline waveform derivation in spine surgery was 2% in our series. This was significantly more likely in high-risk surgery for thoracic lesions and OPLL, and in cases with preoperative severe motor deficit. In such cases, it may be preferable to use multiple modalities for IONM to derive multichannel waveforms from distal limb muscles, including the AH.Level of Evidence: 3.
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Frequency and Implications of Concurrent Complications Following Adult Spinal Deformity Corrective Surgery. Spine (Phila Pa 1976) 2021; 46:E1155-E1160. [PMID: 34618707 DOI: 10.1097/brs.0000000000004064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications. METHODS Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication co-occurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point. RESULTS Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3+. Overall, 11% of complication co-occurrences were pulmonary/cardiovascular, 9% pulmonary/renal, and 4% integumentary/renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time ≥400 minutes and fusion ≥9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade ≥2 and age ≥65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R2 = 0.202, P < 0.001), non-home discharge (R2 = 0.111, P = 0.001), and readmission (R2 = 0.010, P < 0.001). CONCLUSION For surgical ASD patients, the overall rate of co-occurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.Level of Evidence: 3.
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McDonnell JM, Ahern DP, Wagner SC, Morrissey PB, Kaye ID, Sebastian AS, Butler JS. A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery. Clin Spine Surg 2021; 34:347-354. [PMID: 34232153 DOI: 10.1097/bsd.0000000000001224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junctional failure (DJF) is less well understood. STUDY DESIGN A systematic review was carried out. OBJECTIVES The primary objective is to identify the risk factors associated with DJF. The secondary objective is to delineate the incidence rate and causative factors associated with DJF. METHODS A systematic review of articles in Medline/PubMed and The Cochrane Library databases was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. Data was collated to determine the prevalence of DJF and overall revision rates, and identify potential risk factors for development of DJF. RESULTS Twelve studies were included for systematic review. There were 81/2261 (3.6%) cases of DJF. Overall, DJF represented 27.3% of all revision surgeries. Anterior-posterior surgery had a reduced incidence of postoperative DJF [5.0% vs. 8.7%; P=0.08; relative risk (RR)=1.73], as did patients below 60 years of age at the time of surgery (2.9% vs. 3.9%; P=0.09; RR=1.34). There was a higher incidence of DJF among those patients who received interbody fusion (9.9% vs. 5.1%; P=0.06; RR=1.93) compared with those who did not. However, none of these findings reached statistical significance. There were significantly more rates of DJF for fusions ending on L5 compared with constructs fused to the sacrum (11.7% vs. 3.6%; P=0.02; RR=3.28). CONCLUSIONS Cohorts 60 years and above of age at the time of surgery and patients managed with posterior-only fusion or interbody fusion have increased incidences of DJF. Fusion to L5 instead of the sacrum significantly influences DJF rates. However, the quality of available evidence is low and further high-quality studies are required to more robustly analyze the clinical, radiographic, and surgical risk factors associated with the development of DJF after ASD surgery.
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Affiliation(s)
| | - Daniel P Ahern
- School of Medicine, Trinity College Dublin
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Scott C Wagner
- Division of Orthopedics, Walter Reed National Military Medical Center, Washington, DC
| | - Patrick B Morrissey
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA
| | - Ian D Kaye
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Joseph S Butler
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Lakomkin N, Stannard B, Fogelson JL, Mikula AL, Lenke LG, Zuckerman SL. Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations. Spine J 2021; 21:1784-1792. [PMID: 34332146 DOI: 10.1016/j.spinee.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) surgeries are complex, involving long operative times and surgical morbidity. It is currently unclear how the invasiveness of ASD surgery compares to other major operations. PURPOSE To: (1) develop a quantitative score of surgical morbidity and invasiveness, and (2) compare this score between ASD surgery and other major operations. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE A prospective surgical registry was used to identify all patients undergoing ASD surgery involving ≥ 7 segments. Seventeen additional procedures were included: coronary artery bypass grafting (CABG), pancreatectomy, and esophagectomy, among others. OUTCOME MEASURES Perioperative factors (operative time, transfusions, ventilation) and complications were collected and combined with a previously validated Postoperative Morbidity Survey to create a Surgical Invasiveness and Morbidity Score (SIMS). METHODS Computed scores were compared across surgeries using Welch's t-test. Multiple linear regression modeling was used to compare the SIMS of major surgeries relative to ASD while controlling for patient demographics and comorbidities. RESULTS A total of 1,245,282 surgical patients were included, 4,656 of which underwent ASD surgery. After multiple regression modeling controlling for patient demographics and comorbidities, ASD surgery ranked fourth in SIMS. ASD surgery had a significantly greater SIMS than 13 other major procedures including 6th esophagectomy (adjusted mean difference=-0.05, 95%CI -0.01-0.09, p<.001), 8th pancreatectomy (-0.40, 0.37-0.44, p<.001), 11th craniotomy for tumor (-1.01, 0.98-1.04, p<.001), and 12th sacral chordoma resection (-1.31, 1.26-1.37, p<.001). CONCLUSIONS ASD surgery was associated with significantly greater SIMS than many other major operations, even when controlling for important perioperative factors. These data have implications for patient counseling, resource allocation, and informed consent.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Blaine Stannard
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA; Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA.
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Matsukura Y, Yoshii T, Morishita S, Sakai K, Hirai T, Yuasa M, Inose H, Kawabata A, Utagawa K, Hashimoto J, Tomori M, Torigoe I, Yamada T, Kusano K, Otani K, Sumiya S, Numano F, Fukushima K, Tomizawa S, Egawa S, Arai Y, Shindo S, Okawa A. Comparison of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion as Corrective Surgery for Patients with Adult Spinal Deformity-A Propensity Score Matching Analysis. J Clin Med 2021; 10:jcm10204737. [PMID: 34682860 PMCID: PMC8539171 DOI: 10.3390/jcm10204737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.
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Affiliation(s)
- Yu Matsukura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
- Correspondence: ; Tel.: +81-3-5803-5272; Fax: +81-3-5803-5281
| | - Shingo Morishita
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Masato Yuasa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Atsuyuki Kawabata
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Kurando Utagawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Masaki Tomori
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Ichiro Torigoe
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Kazuyuki Otani
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Satoshi Sumiya
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama 231-8682, Japan; (S.S.); (F.N.)
| | - Fujiki Numano
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama 231-8682, Japan; (S.S.); (F.N.)
| | - Kazuyuki Fukushima
- Department of Orthopaedic Surgery, Saku General Hospital, 3400-28 Nakagomi, Saku 385-0051, Japan;
| | - Shoji Tomizawa
- Department of Orthopaedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu 279-0001, Japan;
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi 332-8558, Japan; (K.S.); (M.T.); (I.T.); (Y.A.)
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzawa Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan; (T.Y.); (K.K.); (K.O.); (S.S.)
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (Y.M.); (S.M.); (T.H.); (M.Y.); (H.I.); (A.K.); (K.U.); (J.H.); (S.E.); (A.O.)
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Rabinovich EP, Buell TJ, Wang TR, Shaffrey CI, Smith JS. Reduced occurrence of primary rod fracture after adult spinal deformity surgery with accessory supplemental rods: retrospective analysis of 114 patients with minimum 2-year follow-up. J Neurosurg Spine 2021; 35:504-515. [PMID: 34298503 DOI: 10.3171/2020.12.spine201527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rod fracture (RF) after adult spinal deformity (ASD) surgery is reported in approximately 6.8%-33% of patients and is associated with loss of deformity correction and higher reoperation rates. The authors' objective was to determine the effect of accessory supplemental rod (ASR) placement on postoperative occurrence of primary RF after ASD surgery. METHODS This retrospective analysis examined patients who underwent ASD surgery between 2014 and 2017 by the senior authors. Inclusion criteria were age > 18 years, ≥ 5 instrumented levels including sacropelvic fixation, and diagnosis of ASD, which was defined as the presence of pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°, coronal Cobb angle ≥ 20°, or pelvic incidence to lumbar lordosis mismatch ≥ 10°. The primary focus was patients with a minimum 2-year follow-up. RESULTS Of 148 patients who otherwise met the inclusion criteria, 114 (77.0%) achieved minimum 2-year follow-up and were included (68.4% were women, mean age 67.9 years, average body mass index 30.4 kg/m2). Sixty-two (54.4%) patients were treated with traditional dual-rod construct (DRC), and 52 (45.6%) were treated with ASR. Overall, the mean number of levels fused was 11.7, 79.8% of patients underwent Smith-Petersen osteotomy (SPO), 19.3% underwent pedicle subtraction osteotomy (PSO), and 66.7% underwent transforaminal lumbar interbody fusion (TLIF). Significantly more patients in the DRC cohort underwent SPO (88.7% of the DRC cohort vs 69.2% of the ASR cohort, p = 0.010) and TLIF (77.4% of the DRC cohort vs 53.8% of the ASR cohort, p = 0.0001). Patients treated with ASR had greater baseline sagittal malalignment (12.0 vs 8.6 cm, p = 0.014) than patients treated with DRC, and more patients in the ASR cohort underwent PSO (40.3% vs 1.6%, p < 0.0001). Among the 114 patients who completed follow-up, postoperative occurrence of RF was reported in 16 (14.0%) patients, with mean ± SD time to RF of 27.5 ± 11.8 months. There was significantly greater occurrence of RF among patients who underwent DRC compared with those who underwent ASR (21.0% vs 5.8%, p = 0.012) at comparable mean follow-up (38.4 vs 34.9 months, p = 0.072). Multivariate analysis demonstrated that ASR had a significant protective effect against RF (OR 0.231, 95% CI 0.051-0.770, p = 0.029). CONCLUSIONS This study demonstrated a statistically significant decrease in the occurrence of RF among ASD patients treated with ASR, despite greater baseline deformity and higher rate of PSO. These findings suggest that ASR placement may provide benefit to patients who undergo ASD surgery.
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Affiliation(s)
- Emily P Rabinovich
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Thomas J Buell
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Tony R Wang
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Christopher I Shaffrey
- Departments of2Neurological Surgery and
- 3Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Justin S Smith
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
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Adult spinal deformity surgery: posterior three-column osteotomies vs anterior lordotic cages with posterior fusion. Complications, clinical and radiological results. A systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3150-3161. [PMID: 34415448 DOI: 10.1007/s00586-021-06925-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study is to analyse mid- to long-term severe adult spinal deformity (ASD) surgery outcomes by comparing three-column osteotomies (3CO) and multiple anterior interbody fusion cages (AC). MATERIALS AND METHODS The PRISMA flowchart was used to systematically review the literature. Only articles with a minimum 24-month follow-up were examined, and 11 articles were included. The following radiological parameters were observed: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), Cobb angle and T1-sacrum plumbline. Clinical outcome was assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. The main complications were analysed, and the two groups were compared. RESULTS Except for age, the two populations were homogeneous. Both techniques had the same number of posterior instrumented levels (7.4 ± 1.7). The AC group had a mean 3 ± 1.4 interbody fusions per patient. In the PSO group, all patients had 1 3CO and 89.8% of the osteotomies were performed at L2 or L3 vertebrae. No difference was observed between the two groups in terms of clinical outcomes. Both techniques were effective in sagittal parameters restoration with a final PI-LL mismatch = 4.4°. The PSO group had a statistically higher rate of intraoperative blood loss (p = 0.036), major complications, pseudoarthrosis and dural tears (p < 0.001). CONCLUSION Both PSO and multiple AC are effective in treating ASD. Multiple AC seems more suitable when treating older patients because of a lower intraoperative blood loss, lower rate of major complications and fewer number of revision surgeries.
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Wewel JT, Ozpinar A, Walker CT, Okonkwo DO, Kanter AS, Uribe JS. Safety of lateral access to the concave side for adult spinal deformity. J Neurosurg Spine 2021; 35:100-104. [PMID: 33990079 DOI: 10.3171/2020.10.spine191270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) techniques, particularly lateral lumbar interbody fusion (LLIF), have become increasingly popular for adult spinal deformity (ASD) correction. Much discussion has been had regarding theoretical and clinical advantages to addressing coronal curvature from the convex versus concave side of the curve. In this study, the authors aimed to broadly evaluate the clinical outcomes of addressing ASD with circumferential MIS (cMIS) techniques while accessing the lumbar coronal curvature from the concave side. METHODS A multi-institution, retrospective chart and radiographic review was performed for all ASD patients with at least a 10° curvature, as defined by the Scoliosis Research Society, who underwent cMIS correction. The data collected included convex versus concave access to the coronal curve, durable or sensory femoral nerve injury lasting longer than 6 weeks, vascular injury, visceral injury, and any additional major complication, with at least a 2-year follow-up. Neither health-related quality-of-life metrics nor spinopelvic parameters were included within the scope of this study. RESULTS A total of 152 patients with ASD treated with cMIS correction via lateral access were identified and analyzed. Of these, 126 (82.9%) were approached from the concave side and 26 (17.1%) were approached from the convex side. In the concave group, 1 (0.8%) motor and 4 (3.2%) sensory deficit cases remained at 6 weeks after the operation. No vascular, visceral, or catastrophic intraoperative injuries were encountered in the concave group. Of the 26 patients in the convex group, 2 (7.7%) experienced motor deficits lasting longer than 6 weeks and 5 (19.2%) had lower-extremity sensory deficits. CONCLUSIONS It has been reported that lateral access to the convex side is associated with similar clinical and radiographic outcomes with fewer complications when compared with access to the concave side. Advantages to approaching the lumbar spine from the concave side include using one incision to access multiple levels, breaking the operative table to assist with curvature correction, easier access to the L4-5 disc space, the ability to release the contracted side, and, often, avoidance of the need to access or traverse the thoracic cavity. This study illustrates the largest reported cohort of concave access for cMIS scoliosis correction; few postoperative sensory and motor deficits were found.
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Affiliation(s)
- Joshua T Wewel
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Alp Ozpinar
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Corey T Walker
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - David O Okonkwo
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam S Kanter
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan S Uribe
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Chryssikos T, Wessell A, Pratt N, Cannarsa G, Sharma A, Olexa J, Han N, Schwartzbauer G, Sansur C, Crandall K. Enhanced Safety of Pedicle Subtraction Osteotomy Using Intraoperative Ultrasound. World Neurosurg 2021; 152:e523-e531. [PMID: 34098140 DOI: 10.1016/j.wneu.2021.05.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pedicle subtraction osteotomy (PSO) can improve sagittal alignment but carries risks, including iatrogenic spinal cord and nerve root injury. Critically, during the reduction phase of the technique, medullary kinking or neural element compression can lead to neurologic deficits. METHODS We describe 3 cases of thoracic PSO and evaluate the feasibility, findings, and utility of intraoperative ultrasound in this setting. RESULTS Intraoperative ultrasound can provide a visual assessment of spinal cord morphology before and after PSO reduction and influences surgical decision making with regard to the final amount of sagittal plane correction. This modality is particularly useful for confirming ventral decompression of disc-osteophyte complex before reduction and also after reduction maneuvers when there is kinking of the thecal sac but uncertainty about the underlying status of the spinal cord. Intraoperative ultrasound is a reliable modality that fits well into the technical sequence of PSO, adds a minimal amount of operative time, and has few limitations. CONCLUSIONS We propose that intraoperative ultrasound is a useful supplement to standard neuromonitoring modalities for ensuring safe PSO reduction and decompression of neural elements.
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Affiliation(s)
- Timothy Chryssikos
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.
| | - Aaron Wessell
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Gregory Cannarsa
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Nathan Han
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Kenneth Crandall
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
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Effects of Preoperative Motor Status on Intraoperative Motor-evoked Potential Monitoring for High-risk Spinal Surgery: A Prospective Multicenter Study. Spine (Phila Pa 1976) 2021; 46:E694-E700. [PMID: 34027929 DOI: 10.1097/brs.0000000000003994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective multicenter observational study. OBJECTIVE To evaluate transcranial motor-evoked potentials (Tc-MEPs) baseline characteristics of lower limb muscles and to determine the accuracy of Tc-MEPs monitoring based on preoperative motor status in surgery for high-risk spinal disease. SUMMARY OF BACKGROUND DATA Neurological complications are potentially serious side effects in surgery for high-risk spine disease. Intraoperative spinal neuromonitoring (IONM) using Tc-MEPs waveforms can be used to identify neurologic deterioration, but cases with preoperative motor deficit tend to have poor waveform derivation. METHODS IONM was performed using Tc-MEPs for 949 patients in high-risk spinal surgery. A total of 4454 muscles in the lower extremities were chosen for monitoring. The baseline Tc-MEPs was recorded immediately after exposure of the spine. The derivation rate was defined as muscles detected/muscles prepared for monitoring. A preoperative neurological grade was assigned using the manual muscle test (MMT) score. RESULTS The 949 patients (mean age 52.5 ± 23.3 yrs, 409 males [43%]) had cervical, thoracic, thoracolumbar, and lumbar lesions at rates of 32%, 40%, 26%, and 13%, respectively. Preoperative severe motor deficit (MMT ≤3) was present in 105 patients (11%), and thoracic ossification of the posterior longitudinal ligament (OPLL) was the most common disease in these patients. There were 32 patients (3%) with no detectable waveform in any muscles, and these cases had mostly thoracic lesions. Baseline Tc-MEPs responses were obtained from 3653/4454 muscles (82%). Specificity was significantly lower in the severe motor deficit group. Distal muscles had a higher waveform derivation rate, and the abductor hallucis (AH) muscle had the highest derivation rate, including in cases with preoperative severe motor deficit. CONCLUSION In high-risk spinal surgery, Tc-MEPs collected with multi-channel monitoring had significantly lower specificity in cases with preoperative severe motor deficit. Distal muscles had a higher waveform derivation rate and the AH muscle had the highest rate, regardless of the severity of motor deficit preoperatively.Level of Evidence: 3.
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Anterior Lumbar Interbody Fusion (ALIF) L5-S1 with overpowering of posterior lumbosacral instrumentation and fusion mass: a reliable solution in revision spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2323-2332. [PMID: 34081185 DOI: 10.1007/s00586-021-06888-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE In cases of spine surgical revisions of patients affected by sagittal malalignment, the restoration of the ideal lumbar lordosis (LL) is mandatory. ALIF procedures represent a powerful and effective approach to improve the LL in case of hypolordosis. This study evaluates the feasibility of ALIF to overpower posterior lumbar instrumentation and fusion mass in revision spine surgery and secondarily to estimate complications, clinical and radiological outcomes. METHODS This is a single-center retrospective analysis of prospectively collected data on the use of ALIF overpowering in cases of lumbosacral instrumentation and/or fusion. Demographic, comorbidity, corrective strategy adopted, surgical data, clinical and radiological results, and intraoperative and postoperative complications were recorded. RESULTS Twelve patients (3 male; 9 female) underwent overpowering ALIF L5-S1 were included in the study with a mean FU of 34.0 ± 13.4 months. In 10 cases, a posterior titanium instrumentation and fusion mass were present; in 2 patients, only a fusion mass was present. Indicators of pain and disability improved in all patients (p < 0.01). Sagittal realignment with the restoration of ideal spinopelvic parameters was obtained in all cases. One peritoneal lesion requiring intraoperative suture without sequelae, two cases of postoperative radiculopathy, and one posterior wound infection requiring surgical debridement and antibiotic therapy were reported. CONCLUSIONS Anterior implant of lordotic and hyperlordotic cages with increasing segmental lordosis is possible in the presence of posterior instrumentation and/or solid fusion mass. The biomechanical strength of this corrective technique can overcome posterior instrumentation and bone fusion resistance, therefore allowing a single-staged surgery for sagittal realignment.
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The use of electronic PROMs provides same outcomes as paper version in a spine surgery registry. Results from a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2645-2653. [PMID: 33970326 DOI: 10.1007/s00586-021-06834-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Patient-Reported Measured Outcomes (PROMs) are essential to gain a full understanding of a patient's condition, and in spine surgery, these questionnaires are of help when tailoring a surgical strategy. Electronic registries allow for a systematic collection and storage of PROMs, making them readily available for clinical and research purposes. This study aimed to investigate the reliability between the electronic and paper form of ODI (Oswestry Disability Index), SF-36 (Short Form Health Survey 36) and COMI-back (Core Outcome Measures Index for the back) questionnaires. METHODS A prospective analysis was performed of ODI, SF-36 and COMI-back questionnaires collected in paper and electronic format in two patients' groups: Pre-Operatively (PO) or at follow-up (FU). All patients, in both groups, completed the three questionnaires in paper and electronic form. The correlation between both methods was assessed with the Intraclass Correlation Coefficients (ICC). RESULTS The data from 100 non-consecutive, volunteer patients with a mean age of 55.6 ± 15.0 years were analysed. For all of the three PROMs, the reliability between paper and electronic questionnaires results was excellent (ICC: ODI = 0.96; COMI = 0.98; SF36-MCS = 0.98; SF36-PCS = 0.98. For all p < 0.001). CONCLUSIONS This study proved an excellent reliability between the electronic and paper versions of ODI, SF-36 and COMI-back questionnaires collected using a spine registry. This validation paves the way for stronger widespread use of electronic PROMs. They offer numerous advantages in terms of accessibility, storage, and data analysis compared to paper questionnaires.
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Lee NJ, Cerpa M, Leung E, Sardar ZM, Lehman RA, Lenke LG. Do readmissions and reoperations adversely affect patient-reported outcomes following complex adult spinal deformity surgery at a minimum 2 years postoperative? Spine Deform 2021; 9:789-801. [PMID: 33860916 DOI: 10.1007/s43390-020-00235-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Unplanned readmissions and reoperations are known to be associated with undesirable costs and potentially inferior outcomes in complex adult spinal deformity (ASD) surgery. A paucity of literature exists on the impact of readmissions/reoperations on patient-reported outcomes (PRO) in this population. METHODS Consecutively treated adult patients who underwent complex ASD surgery at a single institution from 2015-2018 and minimum 2-year follow-up were studied. Demographics/comorbidities, operative factors, inpatient complications, and postoperative clinical and patient-reported outcomes (SRS-22r, ODI) were assessed for those with and without readmission/reoperation. RESULTS 175 patients (72% female, mean age 52.6 ± 16.4) were included. Mean total instrumented/fused levels was 13.3 ± 4.1, range 6-25. The readmission and reoperation rates were 16.6% and 12%, respectively. The two most common causes of reoperation were pseudarthrosis (5.1%) and PJK (4.0%). Predictors for readmission within 2 years following surgery included pulmonary, cardiac, depression and gastrointestinal comorbidities, along with performance of a VCR, and TLIF. At 2 years postoperatively, those who required a readmission/reoperation had significant increases in SRS and reductions in ODI compared to 1-year and preoperative values. Inpatient complications did not negatively impact 2-year PRO's. The 2-year MCID in PROs was not significantly different between those with and without readmission/reoperation. CONCLUSION Complex ASD surgery carries risk, but the vast majority can achieve MCID (SRS-86.4%, ODI-68.2%) in PROs by 2 years. Importantly, even those with inpatient complications and those who required unplanned readmission/reoperation can improve PROs by 2-year follow-up compared to preoperative baseline and 1-year follow-up and achieve similar improvements compared to those who did not require a readmission. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Meghan Cerpa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Zeeshan M Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Lawrence G Lenke
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
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Kim HJ, Steinhaus M, Punyala A, Shah S, Elysee JC, Lafage R, Riviera T, Mendez G, Ojadi A, Tuohy S, Qureshi S, Urban M, Craig C, Lafage V, Lovecchio F. Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery. Spine J 2021; 21:753-764. [PMID: 33434650 DOI: 10.1016/j.spinee.2021.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Enhanced recovery (ERAS) pathways can help hospitals maximize the incentives of bundled payment models while maintaining high-quality patient care. A key component of an enhanced recovery pathway is the ability to predictably reduce inpatient length of stay, as this is a critical component of the cost equation. PURPOSE To determine the efficacy of an enhanced recovery pathway on reducing length of stay after thoracolumbar adult deformity surgery. STUDY DESIGN Single surgeon retrospective review of prospectively-collected data. PATIENT SAMPLE Forty adult deformity patients who underwent ≥5 levels of fusion to the pelvis (two to L5) with a single surgeon before and after implementation of an ERAS pathway. METHODS The pathway involved participation by anesthesiology, hospital medicine, and physical therapy, and was designed to achieve goals previously associated with decreased LOS (eg, EBL<1200 mL, procedure time <4.5 hours, avoidance of ICU postoperatively, and mobilization POD0-1). Patients were propensity-score matched 1:1 to a historical cohort (enhanced recovery [ER] and historical [H] cohorts), based on demographics, medical comorbidities, radiographic alignment parameters, and surgical factors. Outcomes were compared to determine the effect of the enhanced recovery pathway. Primary outcomes included LOS and 90-day complications and readmissions. RESULTS After matching, gender, BMI, ASA class, preoperative opioid dependence, day of surgery, sagittal alignment parameters, rate of revision surgery, three-column osteotomies, and interbody fusions were comparable between the cohorts (p>.05). In the ER cohort, there was reduced EBL (920±640 vs. 1437±555, p=.004) and no ER patient went to the ICU immediately following surgery, compared with 30% of H patients (p=.022). The ER cohort also had a greater number of patients ambulating by POD1 compared to the H cohort (100% vs. 55%, p=.010). ER patients had a shorter LOS (4.5±1.3 vs. 7.3±4.4 days, p=.010). A 90-day readmission and complications were comparable between the cohorts (p>.05). CONCLUSIONS The creation of an ERAS pathway for patients undergoing thoracolumbar adult deformity surgery reduced length of stay without negatively affecting short-term morbidity and complications. Given the specificity of this pathway to a single surgeon and hospital, the resources and staffing changes that were instrumental in creating the pathway may not be generalizable to other centers.
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Affiliation(s)
- Han Jo Kim
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA.
| | - Michael Steinhaus
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Ananth Punyala
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Sachin Shah
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | | | - Renaud Lafage
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Tom Riviera
- Hospital for Special Surgery, Department of Nursing, 535 East 70th St., New York, NY 10021, USA
| | - Guillermo Mendez
- Hospital for Special Surgery, Department of Nursing, 535 East 70th St., New York, NY 10021, USA
| | - Ajiri Ojadi
- Hospital for Special Surgery, Department of Nursing, 535 East 70th St., New York, NY 10021, USA
| | - Sharlynn Tuohy
- Hospital for Special Surgery, Department of Physical Therapy, 535 East 70th St., New York, NY 10021, USA
| | - Sheeraz Qureshi
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Michael Urban
- Hospital for Special Surgery, Department of Anesthesiology, 535 East 70th St., New York, NY 10021, USA
| | - Chad Craig
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Virginie Lafage
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
| | - Francis Lovecchio
- Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to compare the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and clinical outcomes of patients who did and did not receive posterior ligament complex (PLC) augmentation using a semitendinosus allograft when undergoing long-segment posterior spinal fusion for adult spinal deformity. SUMMARY OF BACKGROUND DATA Clinical research on the augmentation of the PLC to prevent PJK and PJF has been limited to small case series without a comparable control group. METHODS From 2014 to 2019, a consecutive series of patients with adult spinal deformity who underwent posterior long-segment spinal fusion with semitendinosus allograft to augment the PLC (allograft) or without PLC augmentation (control) were identified. Preoperative and postoperative spinopelvic parameters were measured. PJK, PJF, and Oswestry Disability Index (ODI) scores were recorded and compared between the two groups. Univariate and multivariate analysis was performed. P ≤ 0.05 was considered significant. RESULTS Forty-nine patients in the allograft group and 34 patients in the control group were identified. There were no significant differences in demographic variables or operative characteristics between the allograft and control group. Preoperative and postoperative spinopelvic parameters were also similar between the two groups. PJK was present in 33% of patients in the allograft group and 32% of patients in the control group (P = 0.31). PJF did not occur in the allograft group, whereas six patients (18%) in the control group developed PJF (P = 0.01). Postoperative absolute ODI was significantly better in the allograft group (P = 0.007). CONCLUSION The utilization of semitendinosus allograft tendon to augment the PLC at the upper instrumented vertebrae in patients undergoing long-segment posterior spinal fusion for adult deformity resulted in a significant decrease in PJF incidence and improved functional outcomes when compared to a cohort with similar risk of developing PJK and PJFLevel of Evidence: 3.
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Poppenborg P, Liljenqvist U, Gosheger G, Schulze Boevingloh A, Lampe L, Schmeil S, Schulte TL, Lange T. Complications in TLIF spondylodesis-do they influence the outcome for patients? A prospective two-center study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1320-1328. [PMID: 33354744 DOI: 10.1007/s00586-020-06689-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure for degenerative disk disease. While numerous studies have analyzed complication rates and risk factors this study investigates the extent to which complications after TLIF spondylodesis alter the clinical outcome regarding pain and physical function. METHODS A prospective clinical two-center study was conducted, including 157 patients undergoing TLIF spondylodesis with 12-month follow-up (FU). Our study classified complications into three subgroups: none (I), minor (IIa), and major complications (IIb). Complications were considered "major" if revision surgery was required or new permanent physical impairment ensued. Clinical outcome was assessed using visual analog scales for back (VAS-B) and leg pain (VAS-L), and Oswestry Disability Index (ODI). RESULTS Thirty-nine of 157 patients (24.8%) had at least one complication during follow-up. At FU, significant improvement was seen for group I (n = 118) in VAS-B (-50%), VAS-L (-54%), and ODI (-48%) and for group IIa (n = 27) in VAS-B (-40%), VAS-L (-64%), and ODI (-47%). In group IIb (n = 12), VAS-B (-22%, P = 0.089) and ODI (-33%, P = 0.056) improved not significantly, while VAS-L dropped significantly less (-32%, P = 0.013) compared to both other groups. CONCLUSION Our results suggest that major complications with need of revision surgery after TLIF spondylodesis lead to a significantly worse clinical outcome (VAS-B, VAS-L, and ODI) compared to no or minor complications. It is therefore vitally important to raise the surgeon´s awareness of consequences of major complications, and the topic should be given high priority in clinical work.
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Affiliation(s)
- Philipp Poppenborg
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Ulf Liljenqvist
- Department of Spine Surgery, St. Franziskus-Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Germany
| | | | - Lukas Lampe
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Sebastian Schmeil
- Department of Spine Surgery, St. Franziskus-Hospital, Muenster, Germany
| | - Tobias L Schulte
- Department of Orthopaedics and Trauma Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopaedics and Trauma Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Sagittal imbalance and symptoms of depression in adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2450-2456. [PMID: 33222004 DOI: 10.1007/s00586-020-06660-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/10/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE With spinal deformities, mental health can deteriorate due to sagittal imbalance of the spine. The purpose of this study was to clarify the relationship between sagittal imbalance and symptoms of depression among local residents in the community. METHODS This study used data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) in 2010. The sagittal vertical axis (SVA) was identified as an indicator of sagittal imbalance. Symptoms of depression were assessed using the 5-item version of the Mental Health Inventory. Participants were classified into three categories based on the SVA balance as normal (< 40 mm), moderate imbalance (40-95 mm), and severe imbalance (> 95 mm). To evaluate the relationship between sagittal imbalance of the spine and symptoms of depression, the adjusted risk ratio (RR) and the 95% confidence interval (CI) were calculated using a generalized linear model with Poisson link. RESULTS There were 786 participants included in the statistical analysis. Overall, the mean age was 68.1 y (standard deviation, 8.8 y), and 39.4% were men. The prevalence of symptoms of depression by SVA category was 18.6% for normal, 23.8% for moderate, and 40.6% for severe. On multivariate analysis, the RR of SVA for symptoms of depression compared to the normal category was 1.12 (95% CI 0.7-1.70) for the moderate category and 2.29 (95% CI 1.01-5.17) for the severe category. CONCLUSION In local community residents, sagittal imbalance had a significant association with symptoms of depression.
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