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Nagata K, Chang C, Nishizawa M, Yamada K. Estimated number of spine surgeries and related deaths in Japan from 2014 to 2020. J Orthop Sci 2024:S0949-2658(23)00371-8. [PMID: 38168611 DOI: 10.1016/j.jos.2023.12.006] [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] [Received: 10/11/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The total number of spine surgeries per year and their related deaths in Japan has not been adequately estimated in the literature. METHODS We retrospectively reviewed the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) between April 2014 to March 2021, which covers 99.9 % of health insurance claim receipts by general practitioners. The annual number of surgeries was counted using K codes, a procedure classification unique to Japan, and classified into the following six categories; percutaneous vertebroplasty, endoscopic surgery, open discectomy, laminoplasty/laminectomy, instrumentation surgery, and others. The data distribution was also summarized by sex and age. Additionally, by reviewing DPC database-related papers for evaluation of the mortality rate after spine surgery in Japan, the number of spine surgery-related deaths was calculated. RESULTS The NDB showed that the number of spine surgeries analyzed in this study increased from 170,081 in 2014 to 193,903 in 2019, with a slight decrease in 2020. The ratio of instrumentation surgery increased from 33.0 % in 2014 to 37.9 % in 2020. The rate of patients aged 75 or older increased 31.6 % to 39.6 %. Combining these findings with DPC data showing a mortality rate of 0.1 % to 0.4 % revealed that the estimated number of deaths related to spine surgery in Japan ranged from 200 to 800 per year. CONCLUSIONS Approximately 200,000 spine surgeries and 200 to 800 spine surgery-related inpatient deaths were estimated to have occurred in Japan around 2020.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Chang Chang
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Mitsuhiro Nishizawa
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, 94143, United States
| | - Koji Yamada
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan; Nakanoshima Orthopaedics, F&F Haimu, 6-26-2, Nakanoshima, Tama-ku, Kawasaki City 214-0012, Japan
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Anwar FN, Roca AM, Khosla I, Medakkar SS, Loya AC, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100278. [PMID: 37965567 PMCID: PMC10641566 DOI: 10.1016/j.xnsj.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 11/16/2023]
Abstract
Background A growing emphasis on antibiotic stewardship has led to extensive literature regarding antibiotic use in spine surgery for surgical prophylaxis and the treatment of spinal infections. Purpose This article aims to review principles of antibiotic stewardship, evidence-based guidelines for surgical prophylaxis and ways to optimize antibiotics use in the treatment of spinal infections. Methods A narrative review of several society guidelines and spine surgery literature was conducted. Results Antibiotic stewardship in spine surgery requires multidisciplinary investment and consistent evaluation of antibiotic use for drug selection, dose, duration, drug-route, and de-escalation. Developing effective surgical prophylaxis regimens is a key strategy in reducing the burden of antibiotic resistance. For treatment of primary spinal infection, the diagnostic work-up is vital in tailoring effective antibiotic therapy. The future of antibiotics in spine surgery will be highly influenced by improving surgical technique and evidence regarding the role of bacteria in the pathogenesis of degenerative spinal pathology. Conclusions Incorporating evidence-based guidelines into regular practice will serve to limit the development of resistance while preventing morbidity from spinal infection. Further research should be conducted to provide more evidence for surgical site infection prevention and treatment of spinal infections.
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Affiliation(s)
- Fatima N. Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Andrea M. Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Srinath S. Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Alexandra C. Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Dustin H. Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Arash J. Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Gregory D. Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
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Nakamoto H, Nakajima K, Miyahara J, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Nishizawa M, Kawamura N, Kumanomido Y, Higashikawa A, Sasaki K, Takeshita Y, Fukushima M, Iizuka M, Ono T, Yu J, Hara N, Okamoto N, Azuma S, Inanami H, Sakamoto R, Tanaka S, Oshima Y. Does surgical site infection affect patient-reported outcomes after spinal surgery? A multicenter cohort study. J Orthop Sci 2023:S0949-2658(23)00282-8. [PMID: 37903677 DOI: 10.1016/j.jos.2023.10.010] [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] [Received: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Surgical site infections are common in spinal surgeries. It is uncertain whether outcomes in spine surgery patients with vs. without surgical site infection are equivalent. Therefore, we assessed the effects of surgical site infection on postoperative patient-reported outcomes. METHODS We enrolled patients who underwent elective spine surgery at 12 hospitals between April 2017 and February 2020. We collected data regarding the patients' backgrounds, operative factors, and incidence of surgical site infection. Data for patient-reported outcomes, namely numerical rating scale, Neck Disability Index/Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 1 year postoperatively. We divided the patients into with and without surgical site infection groups. Multivariate logistic regression analyses were performed to identify the risk factors for surgical site infection. Using propensity score matching, we obtained matched surgical site infection-negative and -positive groups. Student's t-test was used for comparisons of continuous variables, and Pearson's chi-square test was used to compare categorical variables between the two matched groups and two unmatched groups. RESULTS We enrolled 8861 patients in this study; 74 (0.8 %) developed surgical site infections. Cervical spine surgery and American Society of Anesthesiologists physical status classification ≥3 were identified as risk factors; microendoscopy was identified as a protective factor. Using propensity score matching, we compared surgical site infection-positive and -negative groups (74 in each group). No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the groups. When comparing preoperative with postoperative pain and dysesthesia, statistically significant improvement was observed for both variables in both groups (p < 0.01 for all variables). No significant differences were observed in postoperative outcomes between the matched surgical site infection-positive and -negative groups. CONCLUSIONS Patients with surgical site infections had comparable postoperative outcomes to those without surgical site infections.
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Affiliation(s)
- Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Mitsuhiro Nishizawa
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya-Ku, Tokyo 150-8935, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya-Ku, Tokyo 150-8935, Japan
| | - Yudai Kumanomido
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa 211-8510, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa 211-8510, Japan
| | - Katsuyuki Sasaki
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211, Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa 222-0036, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211, Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa 222-0036, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spine Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo 105-8470, Japan
| | - Masaaki Iizuka
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, Tokyo 162-8543, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, Tokyo 162-8543, Japan
| | - Jim Yu
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-0023, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-0023, Japan
| | - Naoki Okamoto
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama City, Saitama 330-8553, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama City, Saitama 330-8553, Japan
| | - Hirohiko Inanami
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan
| | - Ryuji Sakamoto
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
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Zhang Q, Yang J, Wang W, Liu Z. Effect of extracurricular tutoring on adolescent students cognitive ability: A propensity score matching analysis. Medicine (Baltimore) 2023; 102:e35090. [PMID: 37682126 PMCID: PMC10489514 DOI: 10.1097/md.0000000000035090] [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: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
In recent years, there has been a substantial increase in the number of adolescent students attending extracurricular tutoring. However, extracurricular tutoring, being a distinct form of education, may have varying effects on cognitive capabilities compared to conventional education. Accordingly, the purpose of this paper is to conduct a thorough examination of the effects of extracurricular tutoring on cognitive abilities among adolescent students. The study utilized national data from the China Family Panel Study 2018 to explore the relationship between involvement in extracurricular tutoring among students and cognitive abilities. The study included 2567 valid respondents. A binary logistic regression model was built to determine the factors associated with tutoring involvement while controlling for 19 individual, family, and school factors. Furthermore, a propensity score-matched analysis was conducted in order to mitigate potential bias by using confounding variables identified in the previous step. The study results show that participation in extracurricular tutoring can significantly increase the level of cognitive ability of adolescent students, with adjustments made for age, gender, ethnicity, number of family members, net family income per capita, education and training expenditure in the past years, change of residence for enrollment, change of domicile address for enrollment, locality of the current school, class size, hold a position as a class cadre, average daily study time on weekdays, average study time per day during weekends. The findings imply that the government should provide tutorial subsidies to disadvantaged groups of adolescent students, allocate educational resources equitably, and invest more in education resources in less developed regions to foster fair and healthy development of education and improve the cognitive abilities of young students in the long-term.
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Affiliation(s)
- Qi Zhang
- School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Jiafei Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Wenlong Wang
- School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Zhihong Liu
- Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, China
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Kassicieh AJ, Rumalla K, Segura AC, Kazim SF, Vellek J, Schmidt MH, Shin PC, Bowers CA. Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model. Neurospine 2023; 20:119-128. [PMID: 37016860 PMCID: PMC10080425 DOI: 10.14245/ns.2346110.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/24/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.Methods: Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.Results: Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88).Conclusion: After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.
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Affiliation(s)
- Alexander J. Kassicieh
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Aaron C. Segura
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - John Vellek
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College (NYMC), Valhalla, NY, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Peter C. Shin
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Corresponding Author Christian A. Bowers Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM 81731, USA
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Xue Y, Li S, Wang Y, Zhang H, Cheng L, Wu Y, Wang Q, Wang D, Zou T, Shen J. Unilateral Modified Posterior Lumbar Interbody Fusion Combined With Contralateral Lamina Fenestration Treating Severe Lumbarspinal Stenosis: A Retrospective Clinical Study. Surg Innov 2023; 30:73-83. [PMID: 35505578 DOI: 10.1177/15533506221096016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Study design: Retrospective study. Objectives: The traditional PLIF is routinely utilized in severe lumbar spinal stenosis to relief the nerve compression. Nevertheless, the removal of posterior tension-band structure and the denervation and atrophy of the paraspinal muscle affect the clinical efficacy. Therefore, unilateral modified PLIF combined with contralateral fenestration was performed to overcome above-mentioned drawbacks. Methods: 32 modified PLIF and 33 traditional PLIF cases were retrospectively included. Operation time, length of stay (LOS) and blood loss were recorded. VAS of low back pain and leg pain, ODI and Sf-36 score including physical function and body pain were assessed. Fusion rate, lumbar lordosis (LL), intervertebral angle (IVA) and intervertebral height index (IHI) were evaluated radiologically. Results: Modified group possessed less blood loss, shorter operation time and less LOS. Compared with traditional group, the VAS of back pain was lower at 6 months postoperatively (P < .05) and the ODI score was lower at 3 months postoperatively (P < .05) in modified group. Modified group exhibited better physical function 3 months postoperatively and lower body pain 6 months postoperatively in Sf-36 score (P < .05). No statistic difference in LL, IVA, IHI and fusion rate were observed between both groups. Conclusions: Our modified PLIF combining with contralateral fenestration procedure exhibited particular advantages in comparison to traditional PLIF. The preservation of posterior tension-band structure facilitates to less low back pain, low complication rate and early functional recovery.
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Affiliation(s)
- Yulun Xue
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China.,Department of Orthopeadic Surgery, Changshu Second People's Hospital, the Affiliated Changshu Hospital of Xuzhou Medical University, the Fifth Hospital Affiliated to Yangzhou University, Changshu, China
| | - Suoyuan Li
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Yefeng Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Hong Zhang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Liang Cheng
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Yinghui Wu
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Qiang Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Donglai Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Tianming Zou
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Jun Shen
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
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Asan Z. Early Postoperative Iatrogenic Neuropraxia After Lumbar Disc Herniation Surgery: Analysis of 87 Cases. World Neurosurg 2023; 170:e801-e805. [PMID: 36460197 DOI: 10.1016/j.wneu.2022.11.128] [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: 10/14/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Postoperative early neuropraxia after lumbar disc herniation surgery is common. The emergence of new paresthesia findings with increased sensory and motor deficits in the postoperative period suggests iatrogenic neuropraxia. This study aimed to discuss the causes and prognosis of iatrogenic neuropraxia detected in the early postoperative period in patients who have been operated on for lumbar disc herniation. METHODS Cases with postoperative iatrogenic neuropraxia were determined retrospectively. Deficits were evaluated at intervals of 0-2 hours, 2-12 hours, 12-24 hours, and 24-48 hours. The cases were evaluated in 2 groups as those who underwent aggressive discectomy and simple discectomy. In addition, the treatment results were compared between the 2 groups as the cases that were treated and not treated with methylprednisolone. RESULTS The iatrogenic neuropraxia rate was significantly higher in patients who underwent aggressive discectomy. Although it was observed that paresthesia findings improved more rapidly in cases treated with methylprednisolone, no difference was found between the 2 groups in terms of its effects on the motor deficit. CONCLUSIONS Iatrogenic neuropraxia is a finding whose cause cannot be determined by quantitative criteria. It is common in patients who underwent aggressive discectomy. Methylprednisolone treatment is effective in recovering the paresthesia finding faster and may show that the radicular injury is in the neuropraxia stage in the early period.
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Affiliation(s)
- Ziya Asan
- Department of Neurosurgery, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey.
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Zhang C, Chen L, Li J, Huang D, Zhang W, Lin J. Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-analysis. Clin Spine Surg 2022; 35:341-349. [PMID: 34711752 DOI: 10.1097/bsd.0000000000001268] [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: 04/23/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis study. OBJECTIVE The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS. MATERIALS AND METHODS We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis. RESULTS Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery ( P =0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score ( P =0.005 and 0.03, respectively) and longer 6-month walking distance ( P <0.00001). The patient satisfaction rate was significantly higher in the MSP group ( P =0.02), and the instability rate was significantly lower in the MSP group compared with the CL group ( P <0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase ( P <0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time ( P =0.04). CONCLUSIONS We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate. LEVEL OF EVIDENCE Level III-therapeutic.
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Affiliation(s)
- Chaofan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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9
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Perioperative psychological issues and nursing care among patients undergoing minimally invasive surgeries. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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10
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Page PS, Ammanuel SG, Josiah DT. Evaluation of Endoscopic Versus Open Lumbar Discectomy: A Multi-Center Retrospective Review Utilizing the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) Database. Cureus 2022; 14:e25202. [PMID: 35747045 PMCID: PMC9213256 DOI: 10.7759/cureus.25202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Endoscopic techniques in spine surgery continue to gain popularity due to their potential for decreased blood loss and post-operative pain. However, limited studies have evaluated these techniques within the United States. Additionally, given the limited number of practitioners with experience in endoscopy, most current studies are limited by a lack of heterogeneity. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to evaluate the effect of endoscopic surgery on adverse events. Current Procedural Terminology (CPT) codes for open discectomy were compared with the relevant CPT codes for endoscopic lumbar discectomy. Baseline patient characteristics and adverse outcomes were then compared. Results: A total of 38,497 single-level lumbar discectomies were identified and included. Of these, 175 patients undergoing endoscopic discectomy were compared with 38,322 patients undergoing open discectomy. Endoscopic discectomy demonstrated a shorter operative time of 88.6 minutes than 92.1 minutes in the open group. However, this was not significant (p=0.08). Patients in the endoscopic group demonstrated a shorter total length of stay of 0.81 days vs 1.15 days (p=0.014). Total adverse events were lower in the endoscopic group at 0.6% vs 3.4% in the open group (p=0.03). Conclusion: Endoscopic discectomy demonstrated a significantly lower rate of adverse events and shorter total length of stay than open discectomy. Further research is necessary over time to evaluate larger patient populations as this technology is more rapidly incorporated.
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11
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Morishita S, Yoshii T, Inose H, Hirai T, Yuasa M, Matsukura Y, Ogawa T, Fushimi K, Okawa A, Fujiwara T. Comparison of perioperative complications in anterior decompression with fusion and posterior decompression with fusion for thoracic ossification of the posterior longitudinal ligament -a retrospective cohort study using a nationwide inpatient database. J Orthop Sci 2022; 27:600-605. [PMID: 33972149 DOI: 10.1016/j.jos.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is a rare disease, which can cause spinal cord compression leading to various neurological symptoms. There are limited treatment options for T-OPLL, surgery is generally considered the only effective treatment. However, few studies have investigated surgical complications in patients with T-OPLL, and there are no data regarding surgical risks in anterior decompression with fusion (ADF) when compared with posterior decompression with fusion (PDF) for T-OPLL. METHODS Patients who were diagnosed as T-OPLL and underwent ADF via the anterior approach and PDF via the posterior approach from April 1, 2012 to March 31, 2018, were extracted from the Diagnosis Procedure Combination (DPC) database. We analyzed perioperative systemic and local complication rates after ADF and PDF and compared them using propensity score matching (PSM) method. In each of the two groups, we investigated the details of length of stay, costs, mortality, and discharge destination. RESULTS In total 1344 patients (ADF: 88 patients, PDF: 1256 patients), 176 patients were investigated after PSM (88 pairs). While the incidence of overall systemic complication was significantly higher in the ADF group (ADF/PDF: 25.0%/8.0%, P = 0.002), there was no significant difference in the overall local complication rate (15.9%/19.3%, P = 0.55). Specifically, respiratory complications were more frequently observed in the ADF group (9.1%/0%, P = 0.004), however, other systemic and local complications did not differ significantly between the two groups. The length of stay was 1.7 times longer (P < 0.001) and the medical costs were 1.4 times higher (P < 0.001) in patients with perioperative complications, compared to those without perioperative complications. CONCLUSION We demonstrated the perioperative complications of ADF and PDF in patients with T-OPLL using a large national database. ADF showed a higher incidence of respiratory complications. Development of perioperative complications was associated with longer hospital stay and higher medical costs.
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Affiliation(s)
- Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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12
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Finneran MM, Naik A, Hawkins JC, Nardone EM. Minimally invasive bilateral decompressive lumbar laminectomy with unilateral approach: patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21676. [PMID: 36130553 PMCID: PMC9379756 DOI: 10.3171/case21676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Minimally invasive bilateral decompressive lumbar laminectomy with a unilateral approach is a less destructive procedure compared to the traditional open bilateral laminectomy. The objective of this study is to report the authors’ experience with this technique. The first 26 cases performed using the unilateral approach for bilateral decompression are described. Baseline characteristics, operative time, blood loss, and intraoperative complications were collected retrospectively. No specific surgical equipment is needed for this technique. OBSERVATIONS Twenty-six patients and a total of 40 lumbar levels were treated. Mean operative time was 82 minutes per level and mean estimated blood loss was 40.4 mL per level. Mean length of hospitalization was 1.65 days. Cerebrospinal fluid leak occurred in 1 of 26 (3.85%) cases. LESSONS Although improved stabilization needs to be proven in future long-term studies to clearly show a decrease in need for fusion, the initial experience with a unilateral approach is positive and continued use in minimally invasive spine surgery seems promising.
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Affiliation(s)
- Megan M. Finneran
- Department of Neurological Surgery, Carle BroMenn Medical Center, Normal, Illinois; and
| | - Anant Naik
- Carle Illinois College of Medicine, Champaign, Illinois
| | - John C. Hawkins
- Department of Neurological Surgery, Carle BroMenn Medical Center, Normal, Illinois; and
| | - Emilio M. Nardone
- Department of Neurological Surgery, Carle BroMenn Medical Center, Normal, Illinois; and
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13
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Oyama R, Arizono T, Inokuchi A, Imamura R, Hamada T, Bekki H. Comparison of Microendoscopic Laminotomy (MEL) Versus Spinous Process-Splitting Laminotomy (SPSL) for Multi Segmental Lumbar Spinal Stenosis. Cureus 2022; 14:e22067. [PMID: 35295365 PMCID: PMC8916905 DOI: 10.7759/cureus.22067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/05/2022] Open
Abstract
Aims This study was aimed to compare the perioperative and postoperative outcomes of patients who underwent posterior decompression for multi-segmental lumbar spinal stenosis by microendoscopic laminotomy (MEL) versus spinous process-splitting laminotomy (SPSL) retrospectively. Methods We retrospectively reviewed 73 consecutive patients who underwent two or three levels MEL (n=51) or SPSL (n=22) for lumbar spinal stenosis between 2012 and 2018. The perioperative outcomes were operative time, intraoperative blood loss, length of postoperative hospital stay, complications, and reoperation rate. The postoperative outcomes were evaluated using a visual analog scale (VAS) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores at one year postoperatively. Results The mean follow-up time was 26.6 months in MEL and 35.6 months in SPSL. The mean operative time was significantly longer in MEL than SPSL (two levels, 183.6 ± 43.2 versus 134.8 ± 26.7 min, respectively; three levels: 241.6 ± 47.8 versus 179.9 ± 28.8 min, respectively). MEL's mean postoperative hospital stay was significantly shorter than SPSL (12.3 ± 5.9 versus 15.5 ± 7.2 days, respectively). There was no significant difference in the mean intraoperative blood loss, complication rate, reoperation rate, and postoperative outcomes between the two groups. Conclusions This study suggests that both techniques are effective in treating multi-segmental lumbar spinal stenosis. There was no significant difference between the two procedures in intraoperative blood loss (IBL), complications rate, reoperation rate, or improvement in VAS and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. MEL had an advantage in the postoperative hospital stay.
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14
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Ohtomo N, Nakamoto H, Miyahara J, Yoshida Y, Nakarai H, Tozawa K, Fukushima M, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Higashikawa A, Takeshita Y, Kawamura N, Inanami H, Tanaka S, Oshima Y. Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study. BMC Musculoskelet Disord 2021; 22:1053. [PMID: 34930238 PMCID: PMC8690517 DOI: 10.1186/s12891-021-04963-6] [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: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.
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Affiliation(s)
- Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hiroyuki Nakarai
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Spine Center, Toranomon Hospital, 2-2-2Minato-Ku, ToranomonTokyo, 105-8470, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hirohiko Inanami
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Inanami Spine and Joint Hospital, 3-17-5Shinagawa-Ku, HigashishinagawaTokyo, 140-0002, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan. .,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.
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15
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Kang TW, Park SY, Oh H, Lee SH, Park JH, Suh SW. Risk of reoperation and infection after percutaneous endoscopic lumbar discectomy and open lumbar discectomy : a nationwide population-based study. Bone Joint J 2021; 103-B:1392-1399. [PMID: 34334035 DOI: 10.1302/0301-620x.103b8.bjj-2020-2541.r2] [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] [Indexed: 01/21/2023]
Abstract
AIMS Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and infection rates continue and are reported to be between 6% and 24% and 0.7% and 16%, respectively. The objective of this study was to compare the rate of reoperation and infection within six months of patients being treated for LDH either by OD or PELD. METHODS In this retrospective, nationwide cohort study, the Korean National Health Insurance database from 1 January 2007 to 31 December 2018 was reviewed. Data were extracted for patients who underwent OD or PELD for LDH without a history of having undergone either procedure during the preceding year. Individual patients were followed for six months through their encrypted unique resident registration number. The primary endpoints were rates of reoperation and infection during the follow-up period. Other risk factors for reoperation and infection were also evalulated. RESULTS Out of 549,531 patients, 522,640 had undergone OD (95.11%) and 26,891 patients had undergone PELD (4.89%). Reoperation rates within six months were 2.28% in the OD group, and 5.38% in the PELD group. Infection rates were 1.18% in OD group and 0.83% in PELD group. The risk of reoperation was lower for patients with OD than for patients with PELD (adjusted hazard ratio (HR) 0.38). The risk of infection was higher for patients with OD than for patients undergoing PELD (HR, 1.325). CONCLUSION Compared with the OD group, the PELD group showed higher reoperation rates and lower infection rates. Cite this article: Bone Joint J 2021;103-B(8):1392-1399.
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Affiliation(s)
- Tae Wook Kang
- Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Si Young Park
- Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Hoonji Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Soon Hyuck Lee
- Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Jong Hoon Park
- Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Seung Woo Suh
- Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
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Nakarai H, Yamada K, Tonosu J, Abe H, Watanabe K, Yoshida Y, Ohya J, Sato Y, Hara N, Okazaki R, Azuma S, Nakamoto H, Kato S, Oshima Y, Tanaka S, Higashikawa A. The Impact of Cefazolin Shortage on Surgical Site Infection Following Spine Surgery in Japan. Spine (Phila Pa 1976) 2021; 46:923-930. [PMID: 34160370 DOI: 10.1097/brs.0000000000003946] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study using prospectively collected data. OBJECTIVE This study aimed to investigate the effect of alternative antimicrobial prophylaxis agents on surgical site infections (SSIs) after spine surgery. SUMMARY OF BACKGROUND DATA Although the use of alternative antimicrobial prophylaxis agents might have a negative effect on SSI prevention, their association with SSI risk in spine surgery remains unclear. METHODS We used the registry data of consecutive patients undergoing spine surgery from April 2017 to January 2020 in four institutions participating in the University of Tokyo Spine Group. Before March 2019, all institutions used cefazolin for antimicrobial prophylaxis. After March 2019, the institutions used broad-spectrum beta-lactam agents as an alternative due to a cefazolin shortage in Japan. RESULTS Among the 3841 enrolled patients (2289 males), 2024 received cefazolin and 1117 received alternative agents. The risk of reoperation for deep SSI within 30 days of spine surgery was significantly higher in the alternative antimicrobial prophylaxis agent group (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI], 1.15-3.35; P = 0.014). In subgroup analyses, the SSI risk was significantly higher in the thoracolumbar surgery group (aOR 1.98; 95% CI, 1.06-3.73; P = 0.03). A nonsignificant consistent trend was found in all other subgroups: posterior decompression (aOR 1.91; 95% CI, 0.86-4.21; P = 0.11); posterior fixation (aOR 2.05; 95% CI, 0.99-4.24; P = 0.05); and cervical spine surgery (aOR 2.30; 95% CI, 0.82-6.46; P = 0.11). CONCLUSION Alternative antimicrobial prophylaxis agents increased the risk of reoperation for SSI after spine surgery compared with cefazolin. Our study supports the current practice of using first-generation cephalosporins as first-line antimicrobial prophylaxis agents in spine surgery as recommended in multiple guidelines.Level of Evidence: 3.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kanagawa, Japan
| | - Koji Yamada
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kanagawa, Japan
| | - Juichi Tonosu
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kanagawa, Japan
| | - Hiroaki Abe
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kanagawa, Japan
| | - Kenichi Watanabe
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kanagawa, Japan
| | - Yuichi Yoshida
- Department of Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junichi Ohya
- Department of Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Rentaro Okazaki
- Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Seiichi Azuma
- Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiro Higashikawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
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17
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Kang MS, Heo DH, Chung HJ, You KH, Kim HN, Choi JY, Park HJ. Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy. J Orthop Surg Res 2021; 16:380. [PMID: 34127017 PMCID: PMC8201903 DOI: 10.1186/s13018-021-02532-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR. Methods This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results Most of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required. Conclusions BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.
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Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery, Bumin Hospital, Republic of, Seoul, Korea
| | - Dong-Hwa Heo
- Department of Neurosurgery, Bumin Hospital, Seoul, Republic of Korea
| | - Hoon-Jae Chung
- Department of Orthopedic Surgery, Bumin Hospital, Republic of, Seoul, Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, Republic of Korea, 07441
| | - Hyong-Nyun Kim
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, Republic of Korea, 07441
| | - Jun-Young Choi
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, Republic of Korea, 07441
| | - Hyun-Jin Park
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, Republic of Korea, 07441.
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Takami M, Yoshida M, Minamide A, Hashizume H, Yukawa Y, Nakagawa Y, Iwasaki H, Tsutsui S, Nagata K, Taiji R, Nishi H, Schoenfeld AJ, Simpson AK, Yamada H. Does prophylactic use of topical gelatin-thrombin matrix sealant affect postoperative drainage volume and hematoma formation following microendoscopic spine surgery? A randomized controlled trial. Spine J 2021; 21:446-454. [PMID: 33189909 DOI: 10.1016/j.spinee.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Microendoscopic spinal surgery has demonstrated efficacy and is increasingly utilized as a minimally invasive approach to neural decompression, but there is a theoretical concern that bleeding and postoperative epidural hematoma (PEH) may occur with increased frequency in a contained small surgical field. Hemostatic agents, such as topical gelatin-thrombin matrix sealant (TGTMS), are routinely used in spine surgery procedures, yet there has been no data on whether PEH is suppressed by these agents when administered in microendoscopic spine surgery. PURPOSE The purpose of this study was to investigate the effect of TGTMS on bleeding and PEH formation in lumbar micoroendoscopic surgery. STUDY DESIGN This is a randomized controlled trial (RCT) with additional prospective observational cohort. PATIENT SAMPLE Patients were registered from July 2017 to September 2018 and a hundred and three patients undergoing microendoscopic laminectomy for lumbar spinal stenosis at a single institution were enrolled in this study. OUTCOME MEASURES The primary outcome was the drainage volume within 48 hours after surgery. Secondary outcomes were the numerical rating scale (NRS) of leg pain on the second (NRS2) and seventh day (NRS7) after surgery and the hematoma area ratio (HAR) in horizontal images on magnetic resonance image (MRI). METHODS In the RCT, 41 cases that received TGTMS (F group) were compared with 41 control group cases (C group) that did not receive TGTMS at the end of the procedure. Drainage volume, NRS2, NRS7, and HAR on MRI were evaluated. Nineteen cases were excluded from the RCT (I group) due to difficulty of hemostasis during surgery and the intentional use of TGTMS for hemostasis. I group was compared with C group in the drainage volume and NRS of leg pain as a prospective observational study. RESULTS The RCT demonstrated no statistically significant difference in drainage volume between those receiving TGTMS (117.0±71.7; mean±standard deviation) and controls (125.0±127.0; p=.345). The NRS2 and NRS7 was 3.5±2.6 and 2.8±2.5 in the F group, respectively, and 3.1±2.6 and 2.1±2.3 in the C group, respectively. The HAR on MRI was 0.19±0.19 in the F group and 0.17±0.13 in the C group. There was no significant difference in postoperative leg pain and HAR (p=.644 for NRS2, p=.129 for NRS7, and p=.705 for HAR). In the secondary observational cohort, the drainage volume in the I group was 118.3±151.4, and NRS2 and NRS7 was 3.5±2.0 and 2.6±2.6, respectively. There were no statistically significant differences in drainage volume (p=.386) or postoperative NRS of leg pain between these two groups (p=.981 and .477 for NRS2 and NRS7, respectively). CONCLUSIONS The prophylactic use of TGTMS in patients undergoing microendoscopic laminotomy for lumbar spinal stenosis did not demonstrate any difference in postoperative bleeding or PEH. Nonetheless, for patients that had active bleeding that required the use of TGTMS, there was no evidence of difference in postoperative clinical outcomes relative to controls.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Wakayama 649-7113, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hideto Nishi
- Department of Orthopaedic Surgery, Hidaka Hospital, 116-2 Sono, Gobo-city, Wakayama 644-0002, Japan
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Abstract
SUMMARY The insights that real-world data (RWD) can provide, beyond what can be learned within the traditional clinical trial setting, have gained enormous traction in recent years. RWD, which are increasingly available and accessible, can further our understanding of disease, disease progression, and safety and effectiveness of treatments with the speed and accuracy required by the health care environment and patients today. Over the decades since RWD were first recognized, innovation has evolved to take real-world research beyond finding ways to identify, store, and analyze large volumes of data. The research community has developed strong methods to address challenges of using RWD and as a result has increased the acceptance of RWD in research, practice, and policy. Historic concerns about RWD relate to data quality, privacy, and transparency; however, new tools, methods, and approaches mitigate these challenges and expand the utility of RWD to new applications. Specific guidelines for RWD use have been developed and published by numerous groups, including regulatory authorities. These and other efforts have shown that the more RWD are used and understood and the more the tools for handling it are refined, the more useful it will be.
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Affiliation(s)
- Robert Zura
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA
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Chiu RG, Patel S, Zhu A, Aguilar E, Mehta AI. Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events. Global Spine J 2020; 10:720-728. [PMID: 32707015 PMCID: PMC7383785 DOI: 10.1177/2192568219872157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study and systematic review. OBJECTIVES Endoscopic decompression offers a minimally invasive alternative to traditional, open laminectomy. However, comparison of these surgical techniques has been largely limited to small, single-center studies. In this study, we perform the first international, multicenter comparison of both with regard to their associated rates of mortality, complications, readmissions, and reoperations. METHODS The 2017 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database, containing data from over 650 hospitals internationally, was queried to evaluate the effect of endoscopic guidance on adverse events. Operative time, length of stay, readmission and reoperation rates, as well as the incidence of peri- and postoperative complications, were compared between endoscopic and open groups. The PubMed/MEDLINE database was queried for studies comparing the techniques. RESULTS A total of 10 726 single-level lumbar decompression patients were identified and included in this study, 34 (0.32%) of whom were operated upon endoscopically. Apart from 2 (5.88%) readmissions, among which only 1 was unplanned, there were no reported surgical complications within the endoscopic group. The mean length of stay for these patients was 0.86 ± 1.44 days, with procedures lasting an average of 91.89 ± 46.72 minutes. However, these endpoints did not differ significantly from the open group. On literature review, 16 studies met the inclusion criteria, and largely consisted of single-center, retrospective analyses. CONCLUSIONS Endoscopically guided approaches to single-level lumbar decompression did not reduce the incidence of adverse events, length of stay or operative time, perhaps due to advances among certain nonendoscopic techniques, such as microsurgery.
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Affiliation(s)
- Ryan G. Chiu
- University of Illinois at Chicago, Chicago, IL, USA
| | - Saavan Patel
- University of Illinois at Chicago, Chicago, IL, USA
| | - Amy Zhu
- University of Illinois at Chicago, Chicago, IL, USA
| | - Eddy Aguilar
- University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I. Mehta
- University of Illinois at Chicago, Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 4 N NPI, Chicago, IL 60612, USA.
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21
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Wu PH, Kim HS, Jang IT. A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery. Neurospine 2020; 17:S20-S33. [PMID: 32746515 PMCID: PMC7410380 DOI: 10.14245/ns.2040116.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022] Open
Abstract
In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin’s triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.
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Affiliation(s)
- Pang Hung Wu
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea.,National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore
| | | | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea
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22
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Incidence and Risk Factors for Postoperative Delirium in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2139834. [PMID: 31886180 PMCID: PMC6899276 DOI: 10.1155/2019/2139834] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Background The present study aims to investigate the incidence and risk factors associated with postoperative delirium in patients undergoing spine surgery. Methods PubMed, EMBASE, Cochrane Library, and Science Citation Index were searched up to August 2019 for studies examining postoperative delirium following spine surgery. Incidence and risk factors associated with delirium were extracted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for outcomes. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation. Results The final analysis includes a total of 40 studies. The pooled analysis reveals that incidence of delirium is 8%, and there are significant differences for developing delirium in age (OR 1.07; 95% CI 1.04-1.09), age more than 65 (OR 4.77; 95% CI 4.37-5.16), age more than 70 (OR 15.87; 95% CI 6.03-41.73), and age more than 80 (OR 1.91; 95% CI 1.78-2.03) years, male (OR 0.81; 95% CI 0.76-0.86), a history of alcohol abuse (OR 2.11; 95% CI 1.67-2.56), anxiety (OR 1.74; 95% CI 1.04-2.44), congestive heart failure (OR 1.4; 95% CI 1.21-1.6), depression (OR 2.5; 95% CI 1.52-3.49), hypertension (OR 1.12; 95% CI 1.04-1.2), kidney disease (OR 1.41; 95% CI 1.16-1.66), neurological disorder (OR 4.66; 95% CI 4.22-5.11), opioid use (OR 1.86; 95% CI 1.18-2.54), psychoses (OR 2.77; 95% CI 2.29-3.25), pulmonary disease (OR 1.81; 95% CI 1.27-2.35), higher mini-mental state examination (OR 0.7; 95% CI 0.5-0.89), preoperative pain (OR 1.88; 95% CI 1.11-2.64), and postoperative urinary tract infection (OR 5.68; 95% CI 2.41-13.39). Conclusions A comprehensive understanding of incidence and risk factors of delirium can improve prevention, diagnosis, and management. Risk of postoperative delirium can be reduced based upon identifiable risk factors.
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The Long-term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease: A Nationwide Sample Cohort Study With a 10-year Follow-up. Spine (Phila Pa 1976) 2019; 44:1382-1389. [PMID: 30973508 DOI: 10.1097/brs.0000000000003065] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study of a nationwide sample database. OBJECTIVE The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion). SUMMARY OF BACKGROUND DATA HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible. METHODS The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type. RESULTS The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD. CONCLUSION The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation. LEVEL OF EVIDENCE 4.
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Butler AJ, Alam M, Wiley K, Ghasem A, Rush Iii AJ, Wang JC. Endoscopic Lumbar Surgery: The State of the Art in 2019. Neurospine 2019; 16:15-23. [PMID: 30943703 PMCID: PMC6449826 DOI: 10.14245/ns.1938040.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022] Open
Abstract
This study was aimed to provide a brief historical perspective to facilitate appreciation of current techniques, describe outcomes of endoscopic lumbar surgery relative to those of existing techniques, and identify topics in need of study and future directions for the field of endoscopic lumbar surgery. Using the PubMed database, a comprehensive search was conducted to identify peer-reviewed English language articles pertaining to endoscopic lumbar surgery. Lack of focus on pertinent techniques or lack of outcome measures constituted exclusion criteria. A majority of included articles were published from 2015–2019. A context with which to appreciate the application of endoscopic lumbar techniques is established. An abundance of case series and several recent comparison studies have documented the benefits and potential pitfalls of these methods in the past two decades. The advantages of endoscopic lumbar spine surgery are widely touted to include reduced perioperative morbidity, including blood loss, operative time and immediate postoperative recovery, minimal structural trauma resulting from surgery, generally positive patient report outcome scores and the potential to contain costs. Additional high-quality research assessing outcomes of endoscopic lumbar surgery are certainly needed and currently expected given the rapid expansion of the field in recent years.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | | | | | - Alexander Ghasem
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Augustus J Rush Iii
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
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25
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Ogihara S, Yamazaki T, Inanami H, Oka H, Maruyama T, Miyoshi K, Takano Y, Chikuda H, Azuma S, Kawamura N, Yamakawa K, Hara N, Oshima Y, Morii J, Okazaki R, Takeshita Y, Tanaka S, Saita K. Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases. PLoS One 2018; 13:e0205539. [PMID: 30325940 PMCID: PMC6191117 DOI: 10.1371/journal.pone.0205539] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023] Open
Abstract
Surgical site infection (SSI) is a significant complication after spinal surgery and is associated with increased hospital length of stay, high healthcare costs, and poor patient outcomes. Accurate identification of risk factors is essential to develop strategies to prevent wound infections. The aim of this prospective multicenter study was to determine the independent factors associated with SSI in posterior lumbar surgeries without fusion (laminectomy and/or herniotomy) for degenerative diseases in adult patients. From July 2010 to June 2014, we conducted a prospective multicenter surveillance study in adult patients who developed SSI after undergoing lumbar laminectomy and/or discectomy in ten participating hospitals. Detailed patient and operative characteristics were prospectively recorded using a standardized data collection format. SSI was based on the Centers for Disease Control and Prevention definition. A total of 4027 consecutive adult patients were enrolled, of which 26 (0.65%) developed postoperative SSI. Multivariate regression analysis indicated two independent factors. An operating time >2 h (P = 0.0095) was a statistically significant independent risk factor, whereas endoscopic tubular surgery (P = 0.040) was a significant independent protective factor. Identification of these associated factors may contribute to surgeons’ awareness of the risk factors for SSI and could help counsel the patients on the risks associated with lumbar laminectomy and/or discectomy. Furthermore, this study’s findings could be used to develop protocols to decrease SSI risk. To the best of our knowledge, this is the first prospective multicenter study that identified endoscopic tubular surgery as an independent protective factor against SSI after lumbar posterior surgery without fusion.
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Affiliation(s)
- Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- * E-mail:
| | - Takashi Yamazaki
- Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Toru Maruyama
- Department of Orthopaedic Surgery, Saitama Rehabilitation Center, Saitama, Japan
| | - Kota Miyoshi
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yuichi Takano
- Department of Orthopaedic Surgery, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, Gunma University, Gunma, Japan
| | - Seiichi Azuma
- Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kiyofumi Yamakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Jiro Morii
- Department of Orthopaedic Surgery, Sanraku Hospital, Tokyo, Japan
| | - Rentaro Okazaki
- Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Yujiro Takeshita
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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