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Iwamae M, Tamai K, Suzuki A, Terai H, Hoshino M, Kato M, Toyoda H, Takahashi S, Yabu A, Sawada Y, Nakamura H. Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy. Clin Spine Surg 2024; 37:E364-E370. [PMID: 38366328 DOI: 10.1097/bsd.0000000000001585] [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: 08/17/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. SUMMARY OF BACKGROUND DATA The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. METHODS Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. RESULTS In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age ( R =-0.358, P =0.002), preoperative JOA score ( R =0.286, P =0.021), preoperative PCS ( R =0.603, P <0.001), C2-C7 lordotic angle ( R =-0.284, P =0.017), stenosis severity ( R =-0.271, P =0.019), and Goutallier classification at the C7 level ( R =-0.268, P =0.021). In multiple linear regression analysis, sex (β=-0.334, P =0.002), age (β=-0.299, P =0.013), preoperative PCS (β=0.356, P =0.009), and Goutallier classification at the C7 level (β=-0.280, P =0.018) were significantly related to 2-year postoperative PCS. CONCLUSIONS Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka
| | - Minori Kato
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedic Surgery, Eniwa Hospital, Hokkaido, Japan
| | - Yuta Sawada
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
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Shakir M, Khowaja AH, Shariq SF, Irshad HA, Tahir I, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Workforce Challenges for the Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Scoping Review. World Neurosurg 2024; 189:387-398.e3. [PMID: 38925244 DOI: 10.1016/j.wneu.2024.06.098] [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: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Limited neurosurgical workforces remain one of the critical problems experienced in low resource settings. Therefore, our study aims to explore and summarize the key challenges to neurosurgical care of brain tumors in terms of workforce in LMICs. A comprehensive literature search was conducted using Scopus, PubMed, CINAHL, and Google Scholar from inception to October 20, 2022. All extracted data were screened independently by 2 reviewers and thematically analyzed. We found and screened 3764 articles, of which 33 studies were included in our final analysis as per our inclusion criteria. Among the studies included, 33% highlighted the limited number of neurosurgeons, 39% emphasized the absence of specialized surgical teams, 7% pointed out a shortage of nursing staff, and 4% noted suboptimal anesthesia teams. The study uncovered the need for improved training programs in neuro-oncology (32%) and neuro-anesthesia (3%), as well as improved collaboration (32%), and multidisciplinary team structures (15%), are essential for tackling these workforce challenges and improving patient outcomes. It is crucial to implement targeted interventions and policy changes to address the barriers to the workforce in providing effective neurosurgical care to patients with brain tumors in developing countries. This might entail capacity building and training programs for healthcare professionals. Policymakers should consider allocating resources and funding for workforce development and making neurosurgical care a priority in healthcare plans.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Ton A, Wishart D, Ball JR, Shah I, Murakami K, Ordon MP, Alluri RK, Hah R, Safaee MM. The Evolution of Risk Assessment in Spine Surgery: A Narrative Review. World Neurosurg 2024; 188:1-14. [PMID: 38677646 DOI: 10.1016/j.wneu.2024.04.117] [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: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Risk assessment is critically important in elective and high-risk interventions, particularly spine surgery. This narrative review describes the evolution of risk assessment from the earliest instruments focused on general surgical risk stratification, to more accurate and spine-specific risk calculators that quantified risk, to the current era of big data. METHODS The PubMed and SCOPUS databases were queried on October 11, 2023 using search terms to identify risk assessment tools (RATs) in spine surgery. A total of 108 manuscripts were included after screening with full-text review using the following inclusion criteria: 1) study population of adult spine surgical patients, 2) studies describing validation and subsequent performance of preoperative RATs, and 3) studies published in English. RESULTS Early RATs provided stratified patients into broad categories and allowed for improved communication between physicians. Subsequent risk calculators attempted to quantify risk by estimating general outcomes such as mortality, but then evolved to estimate spine-specific surgical complications. The integration of novel concepts such as invasiveness, frailty, genetic biomarkers, and sarcopenia led to the development of more sophisticated predictive models that estimate the risk of spine-specific complications and long-term outcomes. CONCLUSIONS RATs have undergone a transformative shift from generalized risk stratification to quantitative predictive models. The next generation of tools will likely involve integration of radiographic and genetic biomarkers, machine learning, and artificial intelligence to improve the accuracy of these models and better inform patients, surgeons, and payers.
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Affiliation(s)
- Andy Ton
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Danielle Wishart
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ishan Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kiley Murakami
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Matthew P Ordon
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael M Safaee
- Department of Neurological Surgery, Keck School of MedicineUniversity of Southern California, Los Angeles, California, USA.
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Balu A, Gensler R, Liu J, Grady C, Brennan D, Cobourn K, Pivazyan G, Deshmukh V. Single-center pilot study of remote therapeutic monitoring in patients with operative spinal pathologies. Clin Neurol Neurosurg 2024; 242:108346. [PMID: 38820944 DOI: 10.1016/j.clineuro.2024.108346] [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: 03/18/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Spine pathology affects a significant portion of the population, leading to neck and back pain, impacting quality of life, and potentially requiring surgical intervention. Current pre- and postoperative monitoring methods rely on patient reported outcome (PRO) measures and lack continuous objective data on patients' recoveries. Remote therapeutic monitoring (RTM) using wearable devices offers a promising solution to bridge this gap, providing real-time physical function data. This study aims to assess the feasibility and correlation between changes in physical function and daily activity levels using RTM for individuals with operative spinal pathologies. METHODS A single-center pilot study involving 21 participants with operative spinal pathologies was conducted at an academic hospital. Participants were provided Bluetooth-enabled Fitbit Inspire 2 activity trackers and asked to wear them daily for 100 days. The Healthcare Recovery Solutions (HRS) mobile application facilitated remote administration of the PROMIS - Physical Function Short Form 6b PROs questionnaire at days 1, 30, and 90. Linear regression, Students' paired T tests, and one-way ANOVA were used to analyze collected data. RESULTS Average compliance with RTM was found to be 82.4% compared to only 48% for PROMs. Changes in daily steps were moderately positively correlated with changes in PROs at both 30 and 90 days. Participant satisfaction with RTM was high, and responses indicated greater satisfaction with RTM compared to PROMs. CONCLUSIONS RTM offers continuous and objective data collection, presenting a potential solution to the limitations of intermittent clinical assessments and self-reported outcomes. The study demonstrated a moderate correlation between changes in activity levels and changes in PROs, suggesting that RTM data could serve as a surrogate for PROs. Participants' high compliance and satisfaction with RTM underscore its feasibility and potential clinical utility. This study lays the groundwork for larger future investigations into the clinical benefits and broader application of RTM in spine care.
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Affiliation(s)
- Alan Balu
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA.
| | - Ryan Gensler
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA
| | - Jiaqi Liu
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA
| | - Clare Grady
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, USA
| | - David Brennan
- MedStar Institute for Innovation (MI2), MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, USA
| | - Kelsey Cobourn
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, USA
| | - Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, USA
| | - Vinay Deshmukh
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, USA
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Findlay MC, Kim RB, Warner WS, Sherrod BA, Park S, Mazur MD, Mahan MA. Identification of an Operative Time Threshold for Substantially Increased Postoperative Complications Among Elderly Spine Surgery Patients. Global Spine J 2024; 14:1532-1541. [PMID: 36623932 PMCID: PMC11394508 DOI: 10.1177/21925682221149390] [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: 01/11/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To identify whether thresholds exist beyond which operative duration or age increases risks for complications among patients ≥65 years undergoing elective spine surgery. METHODS Elective inpatient spine procedures unrelated to infection/trauma/tumor diagnoses in patients <65 years recorded in the 2006-2019 American College of Surgeons National Surgical Quality Improvement database were identified. Univariate analyses was used to compare 30 day complication rates among 5 operative duration and age-stratified groups. To quantify the risk of prolonged operative duration on complications, multivariate analyses were performed controlling for confounders. A generalized linear model was used to assess the individual and combined effect strength of age and operative duration on complication rates. RESULTS Among 87,705 patients stratified by operative duration, 30 day complication rates rose nonlinearly as operative duration increased, with a sharp rise after 4.0-4.9 hours (28.3% at 4.0-4.9 hours, 51.7% at ≥5 hours, P < .001). Multivariate analysis found operative duration was independently associated with increased risk of overall complications (odds ratio 1.10→1.69, P < .001) and medical complications (odds ratio 1.19→1.98, P < .001). Although complication rates rose by age (all P < .001), age was not independently predictive of overall complications within any operative duration group on multivariate analysis. Operative duration had a greater effect (η2P = .067) than age (η2P = .003) on overall complication rates. CONCLUSIONS Increased operative duration was strongly associated with 30 day complication rates, particularly beyond a threshold of 5 hours. Furthermore, operative duration had a notably larger effect on overall complication rates than age.
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Affiliation(s)
- Matthew C Findlay
- School of Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Robert B Kim
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
| | - Wesley S Warner
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
| | | | - Marcus D Mazur
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
| | - Mark A Mahan
- Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA
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de Bhailis ÁM, Lake E, Chrysochou C, Green D, Chinnadurai R, Kalra PA. Improving outcomes in atherosclerotic renovascular disease: importance of clinical presentation and multi-disciplinary review. J Nephrol 2024; 37:1093-1105. [PMID: 38594599 PMCID: PMC11239762 DOI: 10.1007/s40620-024-01902-1] [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: 09/15/2023] [Accepted: 01/15/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Atherosclerotic renal artery stenosis may cause hypertension, chronic kidney disease and heart failure, but large randomized control trials to date have shown no major additional benefit of renal revascularization over optimal medical management. However, these trials did not consider outcomes specifically in relation to clinical presentations. Given that atherosclerotic renal artery stenosis is a heterogenous condition, measures of success likely differ according to the clinical presentation. Our retrospective study objectives were to determine the effects of revascularization when applied to specific clinical presentations and after careful multi-disciplinary team review. METHODS All patients presenting to our centre and its referring hospitals with radiological findings of at least one renal artery stenosis > 50% between January 2015 and January 2020 were reviewed at the renovascular multi-disciplinary team meeting with revascularization considered in accordance with international guidelines, notably for patients with anatomically significant renal artery stenosis, adequately sized kidney and presentations with any of; deteriorating kidney function, heart failure syndrome, or uncontrollable hypertension. Optimal medical management was recommended for all patients which included lipid lowering agents, anti-platelets and anti-hypertensives targeting blood pressure ≤ 130/80 mmHg. The effect of revascularization was assessed according to the clinical presentation; blood pressure and number of agents in those with renovascular hypertension, delta glomerular filtration rate in those with ischaemic nephropathy and heart failure re-admissions in those with heart failure syndromes. RESULTS During this 5-year period, 127 patients with stenosis ≥ 50% were considered by the multidisciplinary team, with 57 undergoing revascularization (17 primarily for severe hypertension, 25 deteriorating kidney function, 6 heart failure syndrome and 9 for very severe anatomical stenosis). Seventy-nine percent of all revascularized patients had a positive outcome specific to their clinical presentation, with 82% of those with severe hypertension improving blood pressure control, 72% with progressive ischaemic nephropathy having attenuated GFR decline, and no further heart failure admissions in those with heart failure. Seventy-eight percent of patients revascularized for high grade stenosis alone had better blood pressure control with 55% also manifesting renal functional benefits. CONCLUSIONS Multi-disciplinary team discussion successfully identified a group of patients more likely to benefit from revascularization based on 3 key factors: clinical presentation, severity of the renal artery lesion and the state of the kidney beyond the stenotic lesion. In this way, a large proportion of patients can clinically improve after revascularization if their outcomes are considered according to the nature of their clinical presentation.
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Affiliation(s)
- Áine M de Bhailis
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Edward Lake
- Department of Vascular Interventional Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Constantina Chrysochou
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Falzetti L, Griffoni C, Carretta E, Pezzi A, Monetta A, Cavallari C, Ghermandi R, Tedesco G, Terzi S, Bandiera S, Evangelisti G, Girolami M, Pipola V, Tosini G, Noli LE, Gasbarrini A, Barbanti Brodano G. Factors associated with increased length of stay and risk of complications in 336 patients submitted to spine surgery. The role of a validated capture system (SAVES v2) as a first-line tool to properly face the problem. 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; 33:1028-1043. [PMID: 38353736 DOI: 10.1007/s00586-023-08036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/13/2023] [Accepted: 10/29/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE In this study, we analyzed the use of a validated capture system (Spinal Adverse Events Severity system, SAVES V2) as a first non-technical skill to properly face the relevant problem of surgical complications (SCs) and adverse events (AEs) in spinal surgery. METHODS We retrospectively collected AEs occurring in a tertiary referral center for spine surgery from January 2017 to January 2018 and classified them according to SAVES V2 system. We compared this collection of AEs with a prospective collection performed without any classification system. Univariate and multivariate logistic regression models were used to determined odds ratio (ORs) for selected potential risk factors of AEs and prolonged length of stay. RESULTS Overall a higher number of AEs was retrospectively recorded using SAVES system compared to the prospective recording without the use of any capture system (97/336 vs 210/336, p < 0.001). The length of stay (LOS) increased in the group of complicated patients for all the procedures examined. In the non-oncological group, LOS was significantly higher for complicated patients compared to uncomplicated patients (F = 44.11, p = 0.0000). Similar results have been obtained in the oncological group of patients. In the multivariate regression model surgical time and postoperative AEs emerged as risk factors for prolonged LOS, while only the presence of previous surgeries was confirmed as risk factor for AEs. CONCLUSION Considering that the rate of AEs and SCs in spinal surgery is still high despite the improvement of technical skills, we suggest the use of SAVES V2 capture system as a first-line tool to face the problem.
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Affiliation(s)
- Luigi Falzetti
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Carretta
- Department of Programming and Monitoring, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Pezzi
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Annalisa Monetta
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Carlotta Cavallari
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Terzi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Bandiera
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Marco Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Valerio Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Tosini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luigi Emanuele Noli
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Miękisiak G. Failed Back Surgery Syndrome: No Longer a Surgeon's Defeat-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1255. [PMID: 37512066 PMCID: PMC10384667 DOI: 10.3390/medicina59071255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The introduction of the term Persistent Spinal Pain Syndrome (PSPS-T1/2), replacing the older term Failed Back Surgery Syndrome (FBSS), has significantly influenced our approach to diagnosing and treating post-surgical spinal pain. This comprehensive review discusses this change and its effects on patient care. Various diagnostic methods are employed to elucidate the underlying causes of back pain, and this information is critical in guiding treatment decisions. The management of PSPS-T1/2 involves both causative treatments, which directly address the root cause of pain, and symptomatic treatments, which focus on managing the symptoms of pain and improving overall function. The importance of a multidisciplinary and holistic approach is emphasized in the treatment of PSPS-T1/2. This approach is patient-centered and treatment plans are customized to individual patient needs and circumstances. The review concludes with a reflection on the impact of the new PSPS nomenclature on the perception and management of post-surgical spinal pain.
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Affiliation(s)
- Grzegorz Miękisiak
- Institute of Medicine, University of Opole, 45-040 Opole, Poland
- Vratislavia Medica Hospital, 51-134 Wrocław, Poland
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Lynch BT, Montgomery BK, Verhofste BP, Proctor MR, Hedequist DJ. Two-Surgeon Multidisciplinary Approach to Pediatric Cervical Spinal Fusion: A Single-Institution Series and Review of the Literature. J Pediatr Orthop 2023; 43:392-399. [PMID: 36941115 DOI: 10.1097/bpo.0000000000002396] [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] [Indexed: 03/23/2023]
Abstract
BACKGROUND A collaborative 2-surgeon approach is becoming increasingly popular in surgery but is not widely used for pediatric cervical spine fusions. The goal of this study is to present a large single-institution experience with pediatric cervical spinal fusion using a multidisciplinary 2-surgeon team, including a neurosurgeon and an orthopedic surgeon. This team-based approach has not been previously reported in the pediatric cervical spine literature. METHODS A single-institution review of pediatric cervical spine instrumentation and fusion performed by a surgical team composed of neurosurgery and orthopedics during 2002-2020 was performed. Demographics, presenting symptoms and indications, surgical characteristics, and outcomes were recorded. Particular focus was given to describe the primary surgical responsibility of the orthopedic surgeon and the neurosurgeon. RESULTS A total of 112 patients (54% male) with an average age of 12.1 (range 2-26) years met the inclusion criteria. The most common indications for surgery were os odontoideum with instability (n=21) and trauma (n=18). Syndromes were present in 44 (39%) cases. Fifty-five (49%) patients presented with preoperative neurological deficits (26 motor, 12 sensory, and 17 combined deficits). At the time of the last clinical follow-up, 44 (80%) of these patients had stabilization or resolution of their neurological deficit. There was 1 new postoperative neural deficit (1%). The average time between surgery and successful radiologic arthrodesis was 13.2±10.6 mo. A total of 15 (13%) patients experienced complications within 90 days of surgery (2 intraoperative, 6 during admission, and 7 after discharge). CONCLUSIONS A multidisciplinary 2-surgeon approach to pediatric cervical spine instrumentation and fusion provides a safe treatment option for complex pediatric cervical cases. It is hoped that this study could provide a model for other pediatric spine groups interested in implementing a multi-specialty 2-surgeon team to perform complex pediatric cervical spine fusions. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Benjamin T Lynch
- Department of Orthopaedic Surgery
- Department of Neurosurgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | | | - Bram P Verhofste
- Department of Orthopaedic Surgery
- Harvard Medical School, Boston, MA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
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Norris ZA, Zabat MA, Patel H, Mottole NA, Ashayeri K, Balouch E, Maglaras C, Protopsaltis TS, Buckland AJ, Fischer CR. Multidisciplinary conference for complex surgery leads to improved quality and safety. Spine Deform 2023; 11:1001-1008. [PMID: 36813882 DOI: 10.1007/s43390-023-00667-0] [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: 06/20/2022] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Complex surgery for adult spinal deformity has high rates of complications, reoperations, and readmissions. Preoperative discussions of high-risk operative spine patients at a multidisciplinary conference may contribute to decreased rates of these adverse outcomes through appropriate patient selection and surgical plan optimization. With this goal, we implemented a high-risk case conference involving orthopedic and neurosurgery spine, anesthesia, intraoperative monitoring neurology, and neurological intensive care. METHODS Included in this retrospective review were patients ≥ 18 years old meeting one of the following high-risk criteria: 8 + levels fused, osteoporosis with 4 + levels fused, three column osteotomy, anterior revision of the same lumbar level, or planned significant correction for severe myelopathy, scoliosis (> 75˚), or kyphosis (> 75˚). Patients were categorized as Before Conference (BC): surgery before 2/19/2019 or After Conference (AC): surgery after 2/19/2019. Outcome measures include intraoperative and postoperative complications, readmissions, and reoperations. RESULTS 263 patients were included (96 AC, 167 BC). AC was older than BC (60.0 vs 54.6, p = 0.025) and had lower BMI (27.1 vs 28.9, p = 0.047), but had similar CCI (3.2 vs 2.9 p = 0.312), and ASA Classification (2.5 vs 2.5, p = 0.790). Surgical characteristics, including levels fused (10.6 vs 10.7, p = 0.839), levels decompressed (1.29 vs 1.25, p = 0.863), 3 column osteotomies (10.4% vs 18.6%, p = 0.080), anterior column release (9.4% vs 12.6%, p = 0.432), and revision cases (53.1% vs 52.4%, p = 0.911) were similar between AC and BC. AC had lower EBL (1.1 vs 1.9L, p < 0.001) and fewer total intraoperative complications (16.7% vs 34.1%, p = 0.002), including fewer dural tears (4.2% vs 12.6%, p = 0.025), delayed extubations (8.3% vs 22.8%%, p = 0.003), and massive blood loss (4.2% vs 13.2%, p = 0.018). Length of stay (LOS) was similar between groups (7.2 vs 8.2 days, 0.251). AC had a lower incidence of deep surgical site infections (SSI, 1.0% vs 6.6%, p = 0.038), but a higher rate of hypotension requiring vasopressor therapy (18.8% vs 4.8%, p < 0.001). Other postoperative complications were similar between groups. AC had lower rates of reoperation at 30 (2.1% vs 8.4%, p = 0.040) and 90 days (3.1 vs 12.0%, p = 0.014) and lower readmission rates at 30 (3.1% vs 10.2%, p = 0.038) and 90 days (6.3 vs 15.0%, p = 0.035). On logistic regression, AC patients had higher odds of hypotension requiring vasopressor therapy and lower odds of delayed extubation, intraoperative RBC, and intraoperative salvage blood. CONCLUSIONS Following implementation of a multidisciplinary high-risk case conference, 30- and 90-day reoperation and readmission rates, intraoperative complications, and postoperative deep SSIs decreased. Hypotensive events requiring vasopressors increased, but did not result in longer LOS or greater readmissions. These associations suggest a multidisciplinary conference may help improve quality and safety for high-risk spine patients. particularly through minimizing complications and optimizing outcomes in complex spine surgery.
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Affiliation(s)
- Zoe A Norris
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Michelle A Zabat
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Hershil Patel
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Nicole A Mottole
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Kimberly Ashayeri
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Eaman Balouch
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Constance Maglaras
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Themistocles S Protopsaltis
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Aaron J Buckland
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA
| | - Charla R Fischer
- Spine Research Center, NYU Langone Health Department of Orthopedic Surgery, 306 E. 15th St., New York City, NY, 10003, USA.
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11
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DePledge L, Louie PK, Drolet CE, Shen J, Nemani VM, Leveque JCA, Sethi RK. Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience. Spine Deform 2023; 11:1019-1026. [PMID: 36773216 PMCID: PMC9918809 DOI: 10.1007/s43390-023-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE We sought to determine the incidence, origin, and timeframe of delays to adult spinal deformity surgery so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays. METHODS Complex spine procedures for treatment of adult spinal deformity from 1/1/18 to 8/31/21 were identified. Procedures for infection, tumor, and urgent/emergent cases were excluded. Operations delayed due to COVID or those that were performed outside of our established perioperative care pathway were also excluded. The electronic health record was used to identify the etiology and timeline of all pre- and peri-operative delays. RESULTS Of 235 patients scheduled for complex spine surgery, 193 met criteria for inclusion. Of these patients, 35 patients experienced a surgical delay (18.1%) with a total of 41 delays recorded. Reasons for delay include medically unoptimized (25.6%), intraoperative complication (17.9%), patient directed delay (17.9%), patient illness/injury (15.4%), scheduling complication (10.3%), insurance delay/denial (5.1%), and unknown (2.6%). Twenty-four delays experienced by 22 individuals occurred within 7 days of their scheduled surgery date. CONCLUSION At a single multidisciplinary center, most delays to adult spinal deformity surgery occur before a patient is admitted to the hospital, and for recommendations of additional medical workup/clearance. We suspect that the preoperative protocol might increase pre-admission delays for unoptimized patients, as the protocol is intended to ensure patients receive surgery only when they are medically ready. Further research is needed to determine the economic and system impact of delays related to a preoperative optimization protocol weighed against the reduction in adverse events these protocols can provide.
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Affiliation(s)
- Lisa DePledge
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Philip K Louie
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
| | - Cari E Drolet
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jesse Shen
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Venu M Nemani
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jean-Christophe A Leveque
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Rajiv K Sethi
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
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12
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De la Garza Ramos R. Can We Make Spine Surgery Safer and Better? J Clin Med 2022; 11:jcm11123400. [PMID: 35743470 PMCID: PMC9225388 DOI: 10.3390/jcm11123400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA
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13
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Naidu I, Ryvlin J, Videlefsky D, Qin J, Mowrey WB, Choi JH, Citron C, Gary J, Benton JA, Weiss BT, Longo M, Matmati NN, De la Garza Ramos R, Krystal J, Echt M, Gelfand Y, Cezayirli P, Yassari N, Wang B, Castro-Rivas E, Headlam M, Udemba A, Williams L, Gitkind AI, Yassari R, Yanamadala V. The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:2583. [PMID: 35566709 PMCID: PMC9103560 DOI: 10.3390/jcm11092583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.
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Affiliation(s)
- Ishan Naidu
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Devin Videlefsky
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jiyue Qin
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Wenzhu B. Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Jong H. Choi
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Chloe Citron
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - James Gary
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Joshua A. Benton
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Brandon T. Weiss
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Michael Longo
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Nabil N. Matmati
- School of Medicine, Quinnipiac University, North Haven, CT 06518, USA;
| | - Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Jonathan Krystal
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Murray Echt
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Phillip Cezayirli
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Neeky Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Benjamin Wang
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Erida Castro-Rivas
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Mark Headlam
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Adaobi Udemba
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Lavinia Williams
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Andrew I. Gitkind
- Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Vijay Yanamadala
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
- Hartford HealthCare, Westport, CT 06880, USA
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14
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Kim HJ, Zuckerman SL, Cerpa M, Yeom JS, Lehman RA, Lenke LG. Incidence and Risk Factors for Early Postoperative Complications and Mortality Following Adult Spinal Deformity Surgery: Data From the National Surgical Quality Improvement Program From 2011 to 2013. Clin Spine Surg 2021; 34:E566-E574. [PMID: 34108369 DOI: 10.1097/bsd.0000000000001214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis using the American College of Surgeons National Surgical Quality Improvement Program database. OBJECTIVE The objective of this study was to investigate the incidence and risk factors of perioperative complications and mortality in patients undergoing adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Although ASD surgery has been associated with a relatively high complication rate, a focus on perioperative complications in a large cohort has rarely been reported. MATERIALS AND METHODS In the database of the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program database, a cohort of patients (n=1484) above 20 years and underwent ASD surgery was established by primary and other Current Procedural Terminology and International Classification of Disease, Ninth Revision codes. The incidences of perioperative (within 30 d postsurgery) minor/major complications and mortality was investigated. Risk factors for minor/major complications and mortality were assessed using logistic regression modeling. RESULTS Of 1484 patients undergoing ASD surgery, the overall complication rate was 15.8% (minor complications: 8.2%; major complications: 10.4%), and the mortality rate was 0.6% (9 patients). After multivariate analysis, dependent functional status [P=0.003; odds ratios (ORs), 4.838], anterior or anterior+posterior approaches (P=0.001; OR, 2.022), and prolonged operative time (>5 h) (P=0.004; OR, 1.821) were associated with an increased risk of minor complications. Male sex (P=0.013; OR, 1.567), osteotomy procedure (P=0.008; OR, 1.674) and prolonged operative time (>5 h) (P<0.001; OR, 2.142) were associated with an increased risk of major complications. The American Society of Anesthesiologists 4 status (P=0.009; OR, 34.697) was a strong risk factor for mortality. CONCLUSIONS After ASD surgery, the rates of minor complications, major complications, and mortality was 8.2%, 10.4%, and 0.6%, respectively. While mortality depended on patient physical status represented by the American Society of Anesthesiologists 4, minor and major complications were associated with male sex, dependent functional status, and surgical factors such as osteotomy procedure, prolonged operative time (>5 h), and having an anterior surgical approach. Therefore, this information may be helpful in surgical counseling and preoperative surgical planning.
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Affiliation(s)
- Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Division of Spinal Surgery, The Och Spine Hospital at New York-Presbyterian/Allen Hospital, Columbia University, New York, NY
| | - Scott L Zuckerman
- Department of Orthopedic Surgery, Division of Spinal Surgery, The Och Spine Hospital at New York-Presbyterian/Allen Hospital, Columbia University, New York, NY
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Division of Spinal Surgery, The Och Spine Hospital at New York-Presbyterian/Allen Hospital, Columbia University, New York, NY
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Division of Spinal Surgery, The Och Spine Hospital at New York-Presbyterian/Allen Hospital, Columbia University, New York, NY
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Division of Spinal Surgery, The Och Spine Hospital at New York-Presbyterian/Allen Hospital, Columbia University, New York, NY
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15
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Abstract
The developing field of syndromic neurosurgery has significant challenges and opportunities in quality and safety. Quality care must be safe, effective, patient-centered, timely, efficient, and equitable; the Donabedian model focused on system structures, processes, and outcomes is a helpful framework to guide improvement in these areas. Ultimately, a successful syndromic neurosurgery program will bring together an interested multidisciplinary team of experts who will grow care through open communication and steady improvement efforts.
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Affiliation(s)
- James A Stadler
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Mari L Groves
- Division of Pediatric Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street, Phipps #556, Baltimore, MD 21287, USA
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16
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Brockmeyer DL. Editorial. The walls come tumbling down: a proposed two-specialty approach to complex pediatric spinal deformity surgery. J Neurosurg Pediatr 2021; 28:247-248. [PMID: 34214983 DOI: 10.3171/2021.1.peds20955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Veronesi F, Borsari V, Martini L, Visani A, Gasbarrini A, Brodano GB, Fini M. The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies. Aging Dis 2021; 12:625-645. [PMID: 33815887 PMCID: PMC7990375 DOI: 10.14336/ad.2020.0904] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022] Open
Abstract
Frailty is a condition characterized by a high vulnerability to low-power stressor. Frailty increases with age and is associated with higher complications and mortality. Several indexes have been used to quantify frailty. Spine diseases, both degenerative and oncologic, frequently require surgery which is related to complications and mortality. Aim of the present systematic review was to collect the most frequently used frailty indexes in clinics to predict surgical outcomes in patients affected by spine diseases, taking into account gender differences. Three databases were employed, and 29 retrospective clinical studies were included in this systematic review. The identified spine pathologies were primary and metastatic spine tumors, adult spine deformity (ASD), degenerative spine disease (DSD), cervical deformity (CD) and other pathologies that affected lumbar spine or multiple spine levels. Eleven indexes were identified: modified Frailty Index (mFI), Adult spinal deformity frailty index (ASD-FI), mFI-5, Metastatic Spinal Tumor Frailty Index (MSTFI), Fried criteria, Cervical deformity frailty index (CD-FI), Spinal tumor frailty index (STFI), Frailty Phenotype criteria (FP), Frailty Index (FI), FRAIL scale and Modified CD-FI (mCD-FI). All these indexes correlated well with minor and major postoperative complications, mortality and length of stay in hospital. Results on gender differences and frailty are still conflicting, although few studies show that women are more likely to develop frailty and more complications in the post-operative period than men. This systematic review could help the surgeon in the adoption of frailty indexes, before the operation, and in preventing complications in frail patients.
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Affiliation(s)
- Francesca Veronesi
- 1Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Borsari
- 1Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Martini
- 1Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Visani
- 1Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Gasbarrini
- 2Spine Surgery prevalently Oncologic and Degenerative, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Barbanti Brodano
- 2Spine Surgery prevalently Oncologic and Degenerative, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- 1Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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