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van Munster JJCM, Halperin IJY, Ardesch FH, van den Hout WB, van Benthem PPG, Moojen W, Peul WC. Practice variation in surgical treatment for lumbar degenerative disc disease: exploring regional and hospital factors influencing surgical rates. Sci Rep 2024; 14:9273. [PMID: 38653739 DOI: 10.1038/s41598-024-59629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and prefer. Historically, high practice variation in surgical treatment for lumbar degenerative disc disease (LDDD) has been documented. This study aimed to investigate current regional variation in surgical treatment for sciatica resulting from LDDD. We conducted a retrospective, cross-sectional analysis of all Dutch adults (>18 years) between 2016 and 2019. Demographic data from Statistics Netherlands were merged with a nationwide claims database, covering over 99% of the population. Inclusion criteria comprised LDDD diagnosis codes and relevant surgical codes. Practice variation was assessed at the level of postal code areas and hospital service areas (HSAs). Multivariable logistic regression analysis was employed to identify variables associated with surgical treatment. Among the 119,148 hospital visitors with LDDD, 14,840 underwent surgical treatment. Practice variation for laminectomies and discectomies showed less than two-fold variation in both postal code and HSAs. However, instrumented fusion surgery demonstrated a five-fold variation in postal code areas and three-fold variation in HSAs. Predictors of receiving surgical treatment included opioid prescription and patient referral status. Gender differences were observed, with males more likely to undergo laminectomy or discectomy, and females more likely to receive instrumented fusion surgery. Our study revealed low variation rates for discectomies and laminectomies, while indicating a high variation rate for instrumented fusion surgery in LDDD patients. High-quality research is needed on the extent of guideline implementation and its influence on practice variation.
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Affiliation(s)
- Juliëtte J C M van Munster
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands.
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
- Department of Neurosurgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Ilan J Y Halperin
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Frank H Ardesch
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Wouter Moojen
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
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Ratnaparkhi A, Beckett J. Digital Phenotyping, Wearables, and Outcomes. Neurosurg Clin N Am 2024; 35:235-241. [PMID: 38423739 DOI: 10.1016/j.nec.2023.11.009] [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] [Indexed: 03/02/2024]
Abstract
There is a significant need for robust and objective outcome assessments in spine surgery. Constant monitoring via smartphones and wearable devices has the potential to fill this role by providing an in-depth picture of human well-being, creating an unprecedented amount of objective data to augment clinical decision-making. The metrics obtained from continuous patient monitoring increase the amount and ecological validity of data relevant to spine surgery. This can provide physicians with patient and disease-specific medical information, facilitating personalized patient care.
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Affiliation(s)
- Anshul Ratnaparkhi
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles
| | - Joel Beckett
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles; David Geffen School of Medicine, University of California Los Angeles.
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3
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Benites BD, Magnus MM, Costa L, Brunetta DM, Rodriges RDR, Alves SDOC, De Santis GC, Rizzo SRCP, Rabello G, Junior DML. Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Assessment and management of postoperative anemia. Hematol Transfus Cell Ther 2024; 46 Suppl 1:S72-S76. [PMID: 38580494 PMCID: PMC11069069 DOI: 10.1016/j.htct.2024.02.014] [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: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 04/07/2024] Open
Abstract
Postoperative anemia is a complex clinical issue that requires attention due to its ramifications on the patient's recovery and prognosis. Originating from multiple determinants, such as intraoperative blood loss, hemolysis, nutritional deficiencies, systemic inflammation and impact on the bone marrow, postoperative anemia has varied and often challenging presentations. Patients undergoing major surgical procedures, in particular, are susceptible to developing anemia due to the considerable associated blood loss. Accurate diagnosis plays a crucial role in the approach, requiring meticulous hematological analysis, including hemoglobin, hematocrit and reticulocyte count, as well as an in-depth investigation of the underlying causes. An additional challenge arises in the form of the excessive practice of phlebotomy during hospitalization for clinical monitoring. Although it is essential to assess the progression of anemia, frequent removal of blood may contribute to iatrogenic anemia, further delaying recovery and possibly increasing susceptibility to infection.
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Affiliation(s)
- Bruno Deltreggia Benites
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas (Hemocentro UNICAMP), Campinas, SP, Brazil
| | - Mariana Munari Magnus
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas (Hemocentro UNICAMP), Campinas, SP, Brazil
| | - Lorena Costa
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Denise Menezes Brunetta
- Centro de Hematologia e Hemoterapia do Ceará (HEMOCE), Fortaleza, CE, Brazil; Complexo Hospitalar da Universidade Federal do Ceará (EBSERH UFC), Fortaleza, CE, Brazil; Faculdade de Medicina da Universidade Federal do Ceará (FM UFC), Fortaleza, CE, Brazil
| | - Roseny Dos Reis Rodriges
- Hospital Israelita Albert Einstein são Paulo, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | | | - Gil Cunha De Santis
- Hemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Guilherme Rabello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil.
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Bayram F, Göçmen G, Özkan Y. Evaluating risk factors and complications in mandibular ramus block grafting: a retrospective cohort study. Clin Oral Investig 2024; 28:226. [PMID: 38514518 PMCID: PMC10957589 DOI: 10.1007/s00784-024-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This retrospective cohort study aimed to identify the complications and risk factors associated with alveolar grafting using autologous mandibular ramus grafts, guided by the research question: What are the complications encountered in patients undergoing alveolar bone grafting using autologous mandibular ramus block and what are the risk factors associated with the development of these complications? MATERIALS AND METHODS The study included 70 patients who underwent alveolar crest augmentation with autologous mandibular ramus block grafting. Intraoperative, early postoperative, and late postoperative complications were analyzed, as were various risk factors. RESULTS The results showed that the majority of patients had successful outcomes with minimal complications. Sex was found to significantly influence the visibility of the inferior alveolar nerve (IAN). Early postoperative complications were associated with IAN visibility and the use of a single screw for graft fixation. Late postoperative complications were significantly associated with the presence of infection. CONCLUSION The findings emphasize the importance of careful surgical techniques, infection prevention, and patient selection in minimizing complications. CLINICAL RELEVANCE This article may contribute to clinicians' and so patients' understanding of potential risk factors associated with over all ramus block grafting procedure. Based on this information, clinicians can also improve their ability to manage risk factors and associated complications and compare ramus block grafting with other alternatives to determine the best treatment approach for that particular patient.
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Affiliation(s)
- Ferit Bayram
- Department of Oral and Maxillofacial Surgery, Marmara University School of Dentistry, Istanbul, 34854, Turkey.
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Marmara, Basibuyuk Yolu 9/3 34854 Basibuyuk / Maltepe / Istanbul, Istanbul, 34854, Turkey.
| | - Gökhan Göçmen
- Department of Oral and Maxillofacial Surgery, Marmara University School of Dentistry, Istanbul, 34854, Turkey
| | - Yaşar Özkan
- Department of Oral and Maxillofacial Surgery, Marmara University School of Dentistry, Istanbul, 34854, Turkey
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Yang Z, Sun Y, Deng C, Dong X, Hao L. Comparative efficacy of robotic-assisted and freehand techniques for pedicle screw placement in spinal disorders: a meta-analysis and systematic review. J Robot Surg 2024; 18:121. [PMID: 38492043 DOI: 10.1007/s11701-024-01874-1] [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: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
The efficacy and safety of robotic-assisted pedicle screw placement compared to traditional fluoroscopy-guided techniques are of great interest in the field of spinal surgery. This systematic review and meta-analysis aimed to compare the outcomes of these two methods in patients with spinal diseases. Following the PRISMA guidelines, we conducted a systematic search across PubMed, Embase, Web of Science, and Cochrane Library. We included randomized controlled trials comparing robotic-assisted and fluoroscopy-guided pedicle screw placement in patients with spinal diseases. Outcome measures included the accuracy of pedicle screw placement, postoperative complication rates, intraoperative radiation exposure time, and duration of surgery. Data were analyzed using Stata software. Our analysis included 12 studies. It revealed significantly higher accuracy in pedicle screw placement with robotic assistance (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 2.20-3.64, P < 0.01). Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were similar between the two techniques (OR = 0.72, 95% CI = 0.31 to 1.68, P = 0.56 for complication rates; weighted mean difference [WMD] = - 0.13, 95% CI = - 0.93 to 0.68, P = 0.86 for radiation exposure time; WMD = 0.30, 95% CI = - 0.06 to 0.66, P = 0.06 for duration of surgery). Robotic-assisted pedicle screw placement offers superior placement accuracy compared to fluoroscopy-guided techniques. Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were comparable for both methods. Future studies should explore the potential for fewer complications with the robotic-assisted approach as suggested by the lower point estimate.
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Affiliation(s)
- Zhanhua Yang
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Yuhang Sun
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Changcui Deng
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
| | - Xiuhui Dong
- Department of Dermatology, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Liansheng Hao
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
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Planas Gil A, Chárlez Marco A, Loste Ramos A, Peña Jiménez D, Rojas Tomba F, Suñén Sánchez E, Angulo Tabernero M, Tabuenca Sánchez A. Acute complications in open/miss primary and revision thoracolumbar spine surgery: a descriptive study of the most common complications and treatment of choice. INTERNATIONAL ORTHOPAEDICS 2024; 48:555-561. [PMID: 38019296 DOI: 10.1007/s00264-023-06047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Main question The aim of this study is to describe and analyze the frequency of acute perioperative (intraoperatively and 30 days after) complications of open/MISS thoracolumbar spine surgery. Secondary questions A) Describe the treatment of choice for every kind of complication mentioned. B) Perform a bibliographic search and compare the complications described and their frequency with those studied in the manuscript. METHODS A retrospective cohort of 816 patients undergoing spinal surgery over a two year period was analyzed. Acute complications of 59 patients are described whether those with a greater number of levels required longer periods of hospitalization. RESULTS The frequency of acute complications was 7.2%. The most common was infection (2.7%), followed by dural tear (1.7%), and screw malpositioning (1%), which is consistent with the current literature. No statistically significant results were observed when comparing the mean length of hospital stay among patients operated on a greater number of levels compared to the rest (P: 0.344; 95% CI: -3.88-10.93). CONCLUSIONS The subsidiary patient of spinal surgery is getting older and has more comorbidities, and therefore, has a higher risk of complications. Although there are models predicting the risk of complications, they are not used in routine clinical practice. It would be necessary to unify the main criteria and establish guidelines for risk detection and therapeutic algorithms based on new high-quality studies.
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Affiliation(s)
- Alberto Planas Gil
- Hospital General Obispo Polanco (Orthopaedic Surgery and Traumatology Service), Teruel, Spain.
| | - Alfredo Chárlez Marco
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Antonio Loste Ramos
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Diego Peña Jiménez
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Facundo Rojas Tomba
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Enrique Suñén Sánchez
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Marina Angulo Tabernero
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
| | - Antonio Tabuenca Sánchez
- Hospital Universitario Miguel Servet, (Orthopaedic Surgery and Traumatology Service, Spine surgery), Zaragoza, Spain
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Begagić E, Pugonja R, Bečulić H, Selimović E, Skomorac R, Saß B, Pojskić M. The New Era of Spinal Surgery: Exploring the Use of Exoscopes as a Viable Alternative to Operative Microscopes-A Systematic Review and Meta-Analysis. World Neurosurg 2024; 182:144-158.e1. [PMID: 37951465 DOI: 10.1016/j.wneu.2023.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The growing interest in exoscopic (EX) technology has prompted a comprehensive evaluation of its clinical, functional, and financial outcomes in neurosurgery. This systematic review and meta-analysis aimed to explore the utilization of EX in spine surgery and assess their safety, efficacy, and impact on surgical outcomes. METHODS A thorough literature review was conducted using PubMed, Scopus, and Embase databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study focused on articles concerning the application of EXs in spinal surgical procedures. The inclusion criteria encompassed various study designs presenting clinical data and intraoperative experiences related to EX utilization in spine surgery. RESULTS The meta-analysis included studies examining various aspects of EX utilization, such as intraoperative complications, video/image quality, surgical field visualization, ease of manipulation, ergonomic characteristics, educational utility, surgical duration, and team involvement. Findings indicated that EXs offered superior video quality and favorable ergonomic features. Comparable outcomes were observed in surgical duration, intraoperative blood loss, time to discharge, and postoperative pain levels between EX and conventional microscope approaches. CONCLUSIONS This study provides valuable insights into the utilization of EXs in spine surgery, demonstrating their potential advantages and comparable outcomes with conventional microscopes.
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Affiliation(s)
- Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina.
| | - Ragib Pugonja
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina; Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Hakija Bečulić
- Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina; Department of Neurosurgery, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Edin Selimović
- Department of Surgery, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Rasim Skomorac
- Department of Neurosurgery, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina; Department of Surgery, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Benjamin Saß
- Clinic of Neurosurgery, University of Marburg, Marburg, Germany
| | - Mirza Pojskić
- Clinic of Neurosurgery, University of Marburg, Marburg, Germany
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Shah A, Hagedorn JM, Latif U, Bailey-Classen A, Azeem N, Beall DP, Mehta P, Stephens C, Khoo L, Deer TR. Posterior Lateral Arthrodesis as a Treatment Option for Lumbar Spinal Stenosis: Safety and Early Clinical Outcomes. J Pain Res 2024; 17:107-116. [PMID: 38196972 PMCID: PMC10775691 DOI: 10.2147/jpr.s422736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Lumbar spinal stenosis (LSS) is a common condition caused by degenerative changes in the lumbar spine with age. LSS is caused by a variety of factors, including degenerative spondylosis and spondylolisthesis. People suffering with LSS experience neurogenic claudication, which causes severe physical limitations, discomfort, and a decrease in quality of life. Less invasive procedures are now being researched to improve the prognosis, success rate, and safety of LSS treatments. Posterior lateral spinal arthrodesis (PLSA) is a new surgical treatment for LSS. This study looks at the procedural and patient safety of PLSA. Materials and methods This study is a multicenter retrospective analysis of the safety of PLSA who met the clinical indications for PLSA and underwent the procedure at eight interventional spine practices. Data was collected on demographical information, pre-procedural numeric rating scale score (NRS), post-procedural NRS, and complication reporting. Patients who were included had LSS with or without spondylolisthesis and had failed conservative treatments. A descriptive statistical analysis was performed to report the outcomes. Results were reported as mean and standard deviations for continuous outcomes, and frequency (%) for categorical outcomes. Results This retrospective analysis involved 191 patients and 202 PLSA implants. The majority of patients were male Caucasians with a mean age of 69.2 years and a BMI of 31.1. A large majority of implants were placed at the L4-5 level, and the average pre-procedural NRS was 6.3 while the average post-procedural NRS was 3.1, indicating a 50.8% reduction in pain (p < 0.0001). Two patients reported complications, but they were unrelated to the device or surgical procedure; no infections, device malfunctions, or migrations were reported in the patient cohort. Conclusion Preliminary results with PLSA implants indicate that it is a safe treatment option for patients with moderate LSS who do not respond to conservative management.
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Affiliation(s)
- Anuj Shah
- Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS, USA
| | | | - Nomen Azeem
- Florida Spine & Pain Specialists, Riverview, FL, USA
| | | | - Pankaj Mehta
- Pain Specialists of Austin and Central Texas Pain Center, Austin, TX, USA
| | - Chad Stephens
- Noble Pain Management and Sports Medicine, Southlake, TX, USA
| | - Larry Khoo
- The Spine Clinic of Los Angeles, Los Angeles, CA, USA
| | - Timothy Ray Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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9
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Jo D. A comprehensive overview and scope of interventional pain management. Korean J Pain 2024; 37:89-90. [PMID: 38557653 PMCID: PMC10985485 DOI: 10.3344/kjp.24076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
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Kim JY, Oh BH, Kim IS, Hong JT, Sung JH, Lee HJ. The safety and effectiveness of lumbar drainage for cerebrospinal fluid leakage after spinal surgery. Neurochirurgie 2023; 69:101501. [PMID: 37741364 DOI: 10.1016/j.neuchi.2023.101501] [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: 07/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Cerebrospinal fluid (CSF) leakage is a frequent complication after spinal surgery. The lumbar drainage procedure (LDP) is the preferred method for early closure of a dural tear. This study was conducted to assess the safety and effectiveness of LDP after spinal surgery. MATERIALS AND METHODS We retrospectively reviewed 122 patients (55 male and 67 female) who underwent LDP after spinal surgery between January 2010 and June 2021. LDP was performed on patients with suspected CSF leakage due to a dural tear during spinal surgery or in whom mixed-color CSF was observed in the hemo-drain after surgery. LDP was performed aseptically by a resident according to our institution's protocol, and the amount drained was from 200cc to 300cc per day. Absolute bed rest was maintained during the lumbar drainage period. The hemo-drain was opened to confirm that CSF was no longer mixed or oozing, at which time the lumbar drain was removed. Culture was performed at the drain tip when the lumbar drain was removed. RESULTS The spinal surgery level was cervical in 23 patients, thoracic in 27 patients, and lumbar in 72 patients. The mean duration of the indwelling lumbar drain was 7.2 days (2 days-18 days), and the mean amount of drainage was 1198.2cc (100cc-2542cc). Among the 122 patients, the CSF leakage in 101 patients was resolved with the initial procedure, but 21 patients required re-insertion. Of those 21 patients, improper insertion due to a technical problem occurred in 15 patients, poor line fixation occurred in 2 patients, and CSF leakage was again observed after removal of the lumbar drain in 4 patients. In only 1 case was open surgery done after LDP because follow-up magnetic resonance imaging showed a suspected infection. During lumbar drainage, 76 patients used antibiotics, and 46 patients did not. Four patients showed bacterial growth in the tip culture, and 3 of them had been using antibiotics. All 4 of those patients were treated without complications and discharged. Among the 122 patients, 1 patient was discharged with left hemiparesis due to cerebral venous infarction (CVI) and hemorrhage after LDP, and 1 patient underwent re-operation because the CSF collection was not resolved. CONCLUSIONS No major complications such as systemic infection, deep vein thrombosis, or aspiration pneumonia occurred during the lumbar drainage, except for 1 patient (0.8%) with CVI caused by over-drainage. One patient (0.8%) required open surgery after LDP, but no cases of systemic infection occurred while maintaining lumbar drainage, irrespective of antibiotic use. In conclusion, LDP is a safe and effective treatment for CSF leakage after spinal surgery.
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Affiliation(s)
- Jee Yong Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Cheongju, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea.
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Mun J, Hyun SJ, Lee JK, An S, Kim KJ. Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Procedure. Neurospine 2023; 20:981-988. [PMID: 37798992 PMCID: PMC10562243 DOI: 10.14245/ns.2346534.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. METHODS This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). RESULTS Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3-5, 6-9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. CONCLUSION Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.
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Affiliation(s)
- Junho Mun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Ge Z, Zhao W, Wu Z, He J, Zhu G, Song Z, Cui J, Jiang X, Yu W. Hidden Blood Loss and Its Possible Risk Factors in Full Endoscopic Lumbar Interbody Fusion. J Pers Med 2023; 13:jpm13040674. [PMID: 37109060 PMCID: PMC10145574 DOI: 10.3390/jpm13040674] [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: 12/26/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Full endoscopic lumbar interbody fusion (Endo-LIF) is a representative recent emerging minimally invasive operation. The hidden blood loss (HBL) in an Endo-LIF procedure and its possible risk factors are still unclear. METHODS The blood loss (TBL) was calculated by Gross formula. Sex, age, BMI, hypertension, diabetes, ASA classification, fusion levels, surgical approach type, surgery time, preoperative RBC, HGB, Hct, PT, INR, APTT, Fg, postoperative mean arterial pressure, postoperative heart rate, Intraoperative blood loss (IBL), patient blood volume were included to investigate the possible risk factors by correlation analysis and multiple linear regression between variables and HBL. RESULTS Ninety-six patients (23 males, 73 females) who underwent Endo-LIF were retrospective analyzed in this study. The HBL was 240.11 (65.51, 460.31) mL (median [interquartile range]). Fusion levels (p = 0.002), age (p = 0.003), hypertension (p = 0.000), IBL (p = 0.012), PT (p = 0.016), preoperative HBG (p = 0.037) were the possible risk factors. CONCLUSION Fusion levels, younger age, hypertension, prolonged PT, preoperative HBG are possible risk factors of HBL in an Endo-LIF procedure. More attention should be paid especially in multi-level minimally invasive surgery. The increase of fusion levels will lead to a considerable HBL.
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Affiliation(s)
- Zhilin Ge
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Wenhua Zhao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhihua Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jiahui He
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Guangye Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Weibo Yu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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Beucler N. Comparison between cervical lateral mass screw and cervical pedicle screw surgery. Neurosurg Rev 2023; 46:78. [PMID: 36977816 DOI: 10.1007/s10143-023-01985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, 83800, Toulon Cedex 9, France.
- Ecole du Val-de-Grâce, French Military Health Service Academy, 1 Place Alphonse Laveran, Paris 5, 75230, France.
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