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Shahzad H, Saade A, Tse S, Simister SK, Azhar H, Le H, Khan SN. Comparing opioid utilization and costs for surgical management of single-level spondylolisthesis: A national claims database analysis. J Orthop 2024; 57:44-48. [PMID: 38973969 PMCID: PMC11225719 DOI: 10.1016/j.jor.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction The rise in degenerative lumbar spondylolisthesis (DLS) cases has led to a significant increase in fusion surgeries, which incur substantial hospitalization costs and often necessitate chronic opioid use for pain management. Recent evidence suggests that single-level low-grade DLS outcomes are comparable whether a fusion procedure or decompression alone is performed, sparking debate over the cost-effectiveness of these procedures, particularly with the advent of minimally invasive techniques reducing the morbidity of fusion. This study aims to compare chronic opioid utilization and associated costs between decompression alone and decompression with instrumented fusion for single-level degenerative lumbar spondylolisthesis. Material and methods Using data from the PearlDiver database, a retrospective database analysis was conducted. We analyzed records of Medicare and Medicaid patients undergoing lumbar fusion or decompression from 2010 to 2022. Patient cohorts were divided into decompression alone (DA) and decompression with instrumented fusion (DIF). Chronic opioid use, pain clinic visits, and total costs were compared between the two groups at 90 days, 1 year, and 2 years post-surgery. Theory Does DIF offer a more cost-effective approach to managing DLS in terms of chronic opioid use in single-level DLS patients. Results The study revealed comparable chronic opioid use and pain clinic visits between DA and DIF groups at 90 days and 1 year. However, total costs associated with opioid prescriptions as well as surgical aftercare were significantly higher in the DIF group at 90 days (p < 0.05), 1 year (p < 0.05), and 2 years (p < 0.05) post-surgery compared to the DA group. Conclusions This study highlights the higher costs associated with DIF up to 2 years post-surgery despite comparable symptom improvement when compared to DA and DIF at the 1-year interval. DA emerges as a more financially favorable option, challenging the notion of fusion's cost-offsetting benefits. While further investigation is needed to understand underlying cost drivers and optimize outcomes, our findings emphasize the necessity of integrating clinical and economic factors in the management of single-level DLS.
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Affiliation(s)
- Hania Shahzad
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
| | - Aziz Saade
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
| | - Shannon Tse
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
| | | | - Hamza Azhar
- The Ohio State University, Columbus, OH, USA
| | - Hai Le
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
| | - Safdar N. Khan
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
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Shaffer A, Yu AK, Yu A, Huesmann G, Iyer R, Arnold PM. One- and 2-year outcomes of lumbar facet arthroplasty versus spinal fusion in young (<65 years) and old (≥65 years) patients for the treatment of degenerative spondylolisthesis and stenosis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100329. [PMID: 38989291 PMCID: PMC11231454 DOI: 10.1016/j.xnsj.2024.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 07/12/2024]
Abstract
Background Facet arthroplasty, an alternative to lumbar fusion, offers stabilization and preserves range of motion. This subanalysis of the TOPS IDE trial (FDA #G160168) compared facet arthroplasty, using the TOPS device, with a standard single-level transforaminal lumbar interbody fusion (TLIF) in patients stratified by age (<65 and ≥65 years) with symptomatic grade 1 degenerative spondylolisthesis with moderate to severe spinal stenosis at L2-5. Methods Patient-reported outcomes (PROMS), including Oswestry disability index (ODI), visual analog pain scales (VAS), and Zurich claudication questionnaires (ZCQ), were assessed at baseline and multiple postoperative timepoints. Radiographic evaluation of flexion/extension range of motion (ROM) occurred at baseline, 12 months, and 24 months. Data were analyzed following an intention-to-treat model. Significance was defined as p<.05. Results About 299 patients were included (TOPS=206, TLIF=93). The groups were similar at baseline. At 2 years, the TOPS group had a greater proportion of patients report ≥15-point improvement for ODI (93.8% versus 77.1%, p=.011) and ≥20-point improvement for VAS back (84.4% versus 61.8%, p=.014). At 1 year, TOPS group had a greater proportion of patients report clinically significant improvements in all ZCQ categories (91.6% versus 78.5%, p=.012). In patients <65 years, the TOPS group had improved PROMS compared to TLIF at 2 years; however, these differences were less pronounced in patients ≥65 years old. The TOPS groups preserved more ROM at 12 (2.8° 95%CI [1.87; 3.74], p<.0001) and 24 (2.99° 95%CI [1.82; 4.15], p<.0001) months compared to TLIF. ROM was similarly preserved in patients aged <65 and ≥65. The rate of adverse events did not differ significantly between treatment groups. Conclusions Facet arthroplasty preserves more ROM in all ages and leads to improved PROMS compared to TLIF, particularly in younger patients.
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Affiliation(s)
- Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Alexander K. Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA 15212, United States
| | - Albert Yu
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Graham Huesmann
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
- Department of Neurology, Carle Foundation Hospital, Urbana, IL 61801, United States
| | - Ravishanker Iyer
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Paul M. Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL 61801, United States
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Kaidi AC, Du JY, Subramanian T, Amen T, Asada T, Qureshi SA, Iyer S. Isolated decompression for degenerative spondylolisthesis is less costly than fusion even with high revision rates. Spine J 2024; 24:1690-1696. [PMID: 38849052 DOI: 10.1016/j.spinee.2024.05.004] [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: 11/08/2023] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND CONTEXT Isolated decompression and decompression with instrumented fusion are accepted surgical treatments for lumbar spondylolisthesis. Although isolated decompression is a less costly solution with similar patient-reported outcomes, it is associated with higher rates of reoperation than primary fusion. PURPOSE To determine the costs associated with primary decompression, primary fusion, and decompression and fusion for degenerative spondylolisthesis. We further sought to establish at what revision rate is primary decompression still a less costly surgical treatment for degenerative lumbar spondylolisthesis. STUDY DESIGN/SETTING A retrospective database study of the Medicare Provider Analysis and Review (MEDPAR) limited data set. PATIENT SAMPLE Patients who underwent single-level fusion or decompression for degenerative spondylolisthesis. OUTCOME MEASURES Cost of surgical care. METHODS All inpatient stays that underwent surgery for single-level lumbar/lumbosacral degenerative spondylolisthesis in the 2019 calendar year (n=6,653) were queried from the MEDPAR limited data set. Patients were stratified into three cohorts: primary decompression (n=300), primary fusion (n=5,757), and revision fusion (n=566). Univariate analysis was conducted to determine cost differences between these groups and results were confirmed with multivariable regression. An economic analysis was then done to determine at what revision rate would primary decompression still be a less costly treatment choice. RESULTS on univariate analysis, the cost of primary single-level decompression for spondylolisthesis was $14,690±9,484, the cost of primary single-level fusion was $26,376±11,967, and revision fusion was $26,686±11,309 (p<0.001). on multivariate analysis, primary fusion was associated with an increased cost of $3,751, and revision fusion was associated with increased cost of $7,502 (95%ci: 2,990-4,512, p<0.001). economic analysis found that a revision rate less than or equal to 43.8% would still result in primary decompression being less costly for a practice than primary fusion for all patients. CONCLUSIONS Isolated decompression for degenerative lumbar spondylolisthesis is a less costly treatment choice even with rates of revision fusion as high as 43.8%. This was true even with an assumed revision rate of 0% after primary fusion. This study solely looks at cost data, however, and many patients may still benefit from primary fusion when appropriately indicated.
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Affiliation(s)
| | - Jerry Y Du
- Hospital for Special Surgery, New York, NY, USA
| | | | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
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4
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Joelson A. Surgery for spinal stenosis with degenerative spondylolisthesis. BMJ 2024; 386:q1628. [PMID: 39111801 DOI: 10.1136/bmj.q1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Anders Joelson
- Department of Orthopaedics, Orebro University Hospital, Orebro, Sweden
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Kgomotso EL, Hellum C, Fagerland MW, Solberg T, Brox JI, Storheim K, Hermansen E, Franssen E, Weber C, Brisby H, Algaard KRH, Furunes H, Banitalebi H, Ljøstad I, Indrekvam K, Austevoll IM. Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial. BMJ 2024; 386:e079771. [PMID: 39111800 PMCID: PMC11304163 DOI: 10.1136/bmj-2024-079771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis. DESIGN Five year follow-up of a randomised, multicentre, non-inferiority trial (Nordsten-DS). SETTING 16 public orthopaedic and neurosurgical clinics in Norway. PARTICIPANTS Patients aged 18-80 years with symptomatic lumbar spinal stenosis and a spondylolisthesis of 3 mm or more at the stenotic level. INTERVENTIONS Decompression surgery alone and decompression with additional instrumented fusion (1:1). MAIN OUTCOME MEASURES The primary outcome was a 30% or more reduction in Oswestry disability index from baseline to five year follow-up. The predefined non-inferiority margin was a -15 percentage point difference in the proportion of patients who met the primary outcome. Secondary outcomes included the mean change in Oswestry disability index, Zurich claudication questionnaire, numeric rating scale for leg and back pain, and EuroQol Group 5-Dimension (EQ-5D-3L) questionnaire. RESULTS From 12 February 2014 to 18 December 2017, 267 participants were randomly assigned to decompression alone (n=134) and decompression with instrumented fusion (n=133). Of these, 230 (88%) responded to the five year questionnaire: 121 in the decompression group and 109 in the fusion group. Mean age at baseline was 66.2 years (SD 7.6), and 69% were women. In the modified intention-to-treat analysis with multiple imputation of missing data, 84 (63%) of 133 people in the decompression alone group and 81 (63%) of 129 people in the fusion group had a at least a 30% reduction in Oswestry disability index, a difference of 0.4 percentage points. (95% confidence interval (CI) -11.2 to 11.9). The respective results of the per protocol analysis were 65 (65%) of 100 in the decompression alone group and 59 (66%) of 89 in the fusion group, a difference of -1.3 percentage points (95% CI -14.5 to 12.2). Both 95% CIs were higher than the predefined non-inferiority margin of -15%. The mean change in Oswestry disability index from baseline to five years was -17.8 in both groups (mean difference 0.02 (95% CI -3.8 to 3.9)). Results of the other secondary outcomes were in the same direction as the primary outcome. From two to five year follow-up, a new lumbar operation occurred in six (5%) of 123 people in the decompression group and 11 (10%) of 113 people in the fusion group, with a total from baseline to five years of 21 (16%) of 129 people and 23 (18%) of 125, respectively. CONCLUSIONS In participants with degenerative spondylolisthesis, decompression alone was non-inferior to decompression with instrumented fusion five years after primary surgery. Proportions of subsequent surgeries at the index level or an adjacent lumbar level were no different between the groups. TRIAL REGISTRATION ClinicalTrials.gov NCT02051374.
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Affiliation(s)
- Eric Loratang Kgomotso
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
| | - Tore Solberg
- Institute of clinical medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- The Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Institute of Health Sciences, Norwegian University of Technology and Science, Ålesund, Norway
| | - Eric Franssen
- Orthopaedic Department, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Helena Brisby
- Spine Surgery Team, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenborg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Håvard Furunes
- Medical Faculty, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Gjøvik, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Ljøstad
- Member of the Norwegian Back and Spine Patients Association
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Yee T, Zammar S, Mummaneni PV. The lumbar interbody fusion trial: TLIF or PLIF for lumbar spondylolisthesis? THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:101000. [PMID: 39070759 PMCID: PMC11283005 DOI: 10.1016/j.lanepe.2024.101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Timothy Yee
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Samer Zammar
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
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7
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Tsukamoto M, Morimoto T, Yoshihara T, Hirata H, Toda Y, Kobayashi T, Mawatari M. Traction Spurs in the Lumbar Spine: A Historical Overview and Future Perspectives. Spine Surg Relat Res 2024; 8:354-361. [PMID: 39131417 PMCID: PMC11310535 DOI: 10.22603/ssrr.2023-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 08/13/2024] Open
Abstract
Numerous studies have explored the connection between lumbar osteophytes, their pathophysiology, and instability since Macnab's 1971 report on traction spurs as an indicator of lumbar instability. This study provides a narrative historical overview of traction spurs, a classic finding that suggests lumbar instability. It summarizes the causes of anterior lumbar vertebral osteophytes, the relationship between traction spurs and lumbar spinal instability, and the clinical significance of traction spurs. Vertebral osteophytes are grouped into two categories, namely, traction spurs or claw spurs, which represent different stages of the same pathological process. Traction spurs are indicative of instability and occur in the early stage of disc degeneration, characterized by temporary dysfunction or instability. Traction spur formation following fusion surgery can predict union or nonunion, and it serves as an indicator of preoperative and postoperative segmental instability. The relationship between traction spurs and radiographic instability, as well as their association with imaging findings such as CT and MRI, has been clarified. Additionally, finite element analysis and mechanical testing have been used to investigate the significance of traction spurs. However, further research is needed to verify that traction spurs are an accurate indicator of pre- and postoperative lumbar instability.
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Affiliation(s)
- Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takaomi Kobayashi
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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8
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Dou X, Liu X, Liu Y, Wang L, Jia F, Shen F, Ma Y, Liang C, Jin G, Wang M, Liu Z, Zhu B, Liu X. Biomimetic Porous Ti6Al4V Implants: A Novel Interbody Fusion Cage via Gel-Casting Technique to Promote Spine Fusion. Adv Healthc Mater 2024:e2400550. [PMID: 39031096 DOI: 10.1002/adhm.202400550] [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: 02/13/2024] [Revised: 06/20/2024] [Indexed: 07/22/2024]
Abstract
An interbody fusion cage (Cage) is crucial in spinal decompression and fusion procedures for restoring normal vertebral curvature and rebuilding spinal stability. Currently, these Cages suffer from issues related to mismatched elastic modulus and insufficient bone integration capability. Therefore, a gel-casting technique is utilized to fabricate a biomimetic porous titanium alloy material from Ti6Al4V powder. The biomimetic porous Ti6Al4V is compared with polyetheretherketone (PEEK) and 3D-printed Ti6Al4V materials and their respective Cages. Systematic validation is performed through mechanical testing, in vitro cell, in vivo rabbit bone defect implantation, and ovine anterior cervical discectomy and fusion experiments to evaluate the mechanical and biological performance of the materials. Although all three materials demonstrate good biocompatibility and osseointegration properties, the biomimetic porous Ti6Al4V, with its excellent mechanical properties and a structure closely resembling bone trabecular tissue, exhibited superior bone ingrowth and osseointegration performance. Compared to the PEEK and 3D-printed Ti6Al4V Cages, the biomimetic porous Ti6Al4V Cage outperforms in terms of intervertebral fusion performance, achieving excellent intervertebral fusion without the need for bone grafting, thereby enhancing cervical vertebra stability. This biomimetic porous Ti6Al4V Cage offers cost-effectiveness, presenting significant potential for clinical applications in spinal surgery.
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Affiliation(s)
- Xinyu Dou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Xiao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Yu Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Linbang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Fei Jia
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Fei Shen
- Laboratory Animal Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Yunlong Ma
- Pain Medical Center, Peking University Third Hospital, Beijing, 100191, China
| | - Chen Liang
- Pain Medical Center, Peking University Third Hospital, Beijing, 100191, China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co., Beijing, 100176, China
| | - Meina Wang
- ZhongAoHuiCheng Technology Co., Beijing, 100176, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Bin Zhu
- Department of Orthopaedics, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, 100050, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
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9
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Leyendecker J, Prasse T, Park C, Köster M, Rumswinkel L, Shenker T, Bieler E, Eysel P, Bredow J, Zaki MM, Kathawate V, Harake E, Joshi RS, Konakondla S, Kashlan ON, Derman P, Telfeian A, Hofstetter CP. 90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients. Neurosurgery 2024:00006123-990000000-01291. [PMID: 39023273 DOI: 10.1227/neu.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Emergency department (ED) utilization and readmission rates after spine surgery are common quality of care measures. Limited data exist on the evaluation of quality indicators after full-endoscopic spine surgery (FESS). The objective of this study was to detect rates, causes, and risk factors for unplanned postoperative clinic utilization after FESS. METHODS This retrospective multicenter analysis assessed ED utilization and clinic readmission rates after FESS performed between 01/2014 and 04/2023 for degenerative spinal pathologies. Outcome measures were ED utilizations, hospital readmissions, and revision surgeries within 90 days postsurgery. RESULTS Our cohort includes 821 patients averaging 59 years of age, who underwent FESS. Most procedures targeted the lumbar or sacral spine (85.75%) while a small fraction involved the cervical spine (10.11%). The most common procedures were lumbar unilateral laminotomies for bilateral decompression (40.56%) and lumbar transforaminal discectomies (25.58%). Within 90 days postsurgery, 8.0% of patients revisited the ED for surgical complications. A total of 2.2% of patients were readmitted to a hospital of which 1.9% required revision surgery. Primary reasons for ED visits and clinic readmissions were postoperative pain exacerbation, transient neurogenic bladder dysfunction, and recurrent disk herniations. Our multivariate regression analysis revealed that female patients had a significantly higher likelihood of using the ED (P = .046; odds ratio: 1.77, 95% CI 1.01-3.1 5.69% vs 10.33%). Factors such as age, American Society of Anesthesiologists class, body mass index, comorbidities, and spanned spinal levels did not significantly predict postoperative ED utilization. CONCLUSION This analysis demonstrates the safety of FESS, as evidenced by acceptable rates of ED utilization, clinic readmission, and revision surgery. Future studies are needed to further elucidate the safety profile of FESS in comparison with traditional spinal procedures.
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Affiliation(s)
- Jannik Leyendecker
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christine Park
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Malin Köster
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena Rumswinkel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tara Shenker
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale-Davie, Florida, USA
| | - Eliana Bieler
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Mark M Zaki
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Varun Kathawate
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward Harake
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rushikesh S Joshi
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Albert Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Farooqi AS, Narayanan R, Canseco JA, Vaccaro AR. Biomechanical Comparison of Corticopedicular Spine Fixation versus Pedicle Screw Fixation in a Lumbar Degenerative Spondylolisthesis Finite Element Analysis Model. World Neurosurg 2024:S1878-8750(24)01201-4. [PMID: 39004177 DOI: 10.1016/j.wneu.2024.07.061] [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: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To compare the stability of a corticopedicular posterior fixation (CPPF) device with traditional pedicle screws for decompression and fusion in adult degenerative lumbar spondylolisthesis. METHODS Finite element analysis (FEA) was used in a validated model of grade 1 L4-L5 spondylolisthesis to compare segmental stability after laminectomy alone, laminectomy with pedicle screw fixation, or laminectomy with CPPF device fixation. A 500-N follower load was applied to the model and different functional movements were simulated by applying a 7.5-Nm force in different directions. Outcomes included degrees of motion, tensile forces experienced in the CPPF device, and stresses in surrounding cortical bone. RESULTS At maximum loading, laminectomy alone demonstrated a 1° increase in flexion range of motion, from 6.35° to 7.39°. Laminectomy with pedicle screw fixation and CPPF device fixation both reduced spinal segmental motion to ≤1° at maximum loading in all ranges of motion, including flexion (0.94° and 1.09°), extension (-0.85° and -1.08°), lateral bending (-0.56° and -0.96°), and torsion (0.63° and 0.91°), respectively. There was no significant difference in segmental stability between pedicle screw fixation and CPPF device fixation during maximum loading, with a difference of ≤0.4° in any range of motion. Tensile forces in the CPPF device remained ≤51% the ultimate load to failure (487 N) and stress in surrounding cortical bone remained ≤84% the ultimate stress of cortical bone (125.4 MPa) during maximum loading. CONCLUSIONS CPFF fixation demonstrated similar segmental stability to traditional pedicle screw fixation whereas tensile forces and stress in surrounding cortical bone remained below the load to failure.
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Affiliation(s)
- Ali S Farooqi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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11
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Muthu S, Ćorluka S, Buser Z, Malcolm JG, Luo Z, Gollahalli Shivashankar P, Ambrosio L, Griffoni C, Demetriades AK, Ivandić S, Wu Y, Wang J, Meisel HJ, Yoon TS. Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis: A Systematic Review of Literature. JB JS Open Access 2024; 9:e23.00163. [PMID: 38974406 PMCID: PMC11221853 DOI: 10.2106/jbjs.oa.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Management of lumbar degenerative spondylolisthesis with decompression-only procedure has been performed for its added benefit of a shorter duration of surgery, lower blood loss, and shorter hospital stay. However, reported failure rates for decompression-only procedures vary depending on the methods utilized for decompression. Hence, we aim to identify the failure rates of individual methods of decompression-only procedures performed for degenerative lumbar spondylolisthesis. Methods An independent systematic review of 4 scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis guidelines. Studies reporting on failure rates defined by reoperation at the index level following decompression-only procedure for degenerative lumbar spondylolisthesis were included for analysis. Studies were appraised using ROBINS tool of Cochrane, and analysis was performed using the Open Meta[Analyst] software. Results The overall failure rate of decompression-only procedure was 9.1% (95% confidence interval [CI] [6.5-11.7]). Furthermore, open decompression had failure rate of 10.9% (95% CI [6.0-15.8]), while microendoscopic decompression had failure rate of 6.7% (95% CI [2.9-10.6]). The failure rate gradually increased from 6.9% (95% CI [2.0-11.7]) at 1 year to 7% (95% CI [3.6-10.3]), 11.7% (95% CI [4.5-18.9]), and 11.7% (95% CI [6.6-16.7]) at 2, 3, and 5 years, respectively. Single level decompression had a failure rate of 9.6% (95% CI [6.3-12.9]), while multilevel decompression recorded a failure rate of 8.7% (95% CI [5.6-11.7]). Conclusion High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1% without significant differences between the decompression techniques. Level of Evidence Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sathish Muthu
- Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Faculty of Engineering, Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Stipe Ćorluka
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York
| | | | - Zhuojing Luo
- Department of Orthopeadic Surgery, Xijing Hospital, China
| | | | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Edinburgh Spinal Surgery Outcome Studies Group, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Stjepan Ivandić
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hans-Jorg Meisel
- Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany
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12
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Wang D, Chen X, Han D, Wang W, Kong C, Lu S. Radiographic and surgery-related predictive factors for increased segmental lumbar lordosis following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis. 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; 33:2813-2823. [PMID: 38637404 DOI: 10.1007/s00586-024-08248-z] [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: 01/18/2024] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL). METHODS A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition. RESULTS A total of 192 patients with an average follow-up of 20.9 months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09 mm vs. 12.21 mm) (all, P < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration (P = 0.047) and higher SP (21.30% vs. 19.39%, P = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P = 0.000), with more extensive reduction of spondylolisthesis (- 73.70% vs. - 56.16%, P = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P = 0.000), more anterior cage position (OR 1.269, P = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P = 0.000) significantly impacted SLL restoration. CONCLUSIONS Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
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13
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Karlsson T, Försth P, Öhagen P, Michaëlsson K, Sandén B. Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical results from a randomized clinical trial. Bone Joint J 2024; 106-B:705-712. [PMID: 38945544 DOI: 10.1302/0301-620x.106b7.bjj-2023-1160.r2] [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: 07/02/2024]
Abstract
Aims We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. Methods The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded. Results Five-year follow-up was completed by 213 (95%) of the eligible patients (mean age 67 years; 155 female (67%)). After five years, ODI was similar irrespective of treatment, with a mean of 25 (SD 18) for decompression alone and 28 (SD 22) for decompression with fusion (p = 0.226). Mean EQ-5D was higher for decompression alone than for fusion (0.69 (SD 0.28) vs 0.59 (SD 0.34); p = 0.027). In the no-DS subset, fewer patients reported decreased leg pain after fusion (58%) than with decompression alone (80%) (relative risk (RR) 0.71 (95% confidence interval (CI) 0.53 to 0.97). The frequency of subsequent spinal surgery was 24% for decompression with fusion and 22% for decompression alone (RR 1.1 (95% CI 0.69 to 1.8)). Conclusion Adding fusion to decompression in spinal stenosis surgery, with or without spondylolisthesis, does not improve the five-year ODI, which is consistent with our two-year report. Three secondary outcomes that did not differ at two years favoured decompression alone at five years. Our results support decompression alone as the preferred method for operating on spinal stenosis.
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Affiliation(s)
- Thomas Karlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Aleris Elisabeth Hospital, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- SDS Life Science, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Sandén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Orthopaedic Clinic, Spine Section, Uppsala University Hospital, Uppsala, Sweden
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14
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Shahi P, Singh S, Morse K, Maayan O, Subramanian T, Araghi K, Singh N, Tuma OC, Asada T, Korsun MK, Dowdell J, Sheha ED, Sandhu H, Albert TJ, Qureshi SA, Iyer S. Impact of age on comparative outcomes of decompression alone versus fusion for L4 degenerative spondylolisthesis. 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 2024:10.1007/s00586-024-08336-0. [PMID: 38907067 DOI: 10.1007/s00586-024-08336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE To compare the outcomes of decompression alone and fusion for L4-5 DLS in different age cohorts (< 70 years, ≥ 70 years). METHODS This retrospective cohort study included patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up. Outcome measures were: (1) patient-reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale back and leg, VAS; 12-Item Short Form Survey Physical Component Score, SF-12 PCS), (2) minimal clinically important difference (MCID), (3) patient acceptable symptom state (PASS), (4) response on the global rating change (GRC) scale, and (5) complication rates. The decompression and fusion groups were compared for outcomes separately in the < 70-year and ≥ 70-year age cohorts. RESULTS 233 patients were included, out of which 52% were < 70 years. Patients < 70 years showed non-significant improvement in SF-12 PCS and significantly lower MCID achievement rates for VAS back after decompression compared to fusion. Analysis of the ≥ 70-year age cohort showed no significant differences between the decompression and fusion groups in the improvement in PROMs, MCID/PASS achievement rates, and responses on GRC. Patients ≥ 70 years undergoing fusion had significantly higher in-hospital complication rates. When analyzed irrespective of the surgery type, both < 70-year and ≥ 70-year age cohorts showed significant improvement in PROMs with no significant difference. CONCLUSIONS Patients < 70 years undergoing decompression alone did not show significant improvement in physical function and had significantly less MCID achievement rate for back pain compared to fusion. Patients ≥ 70 years showed no difference in outcomes between decompression alone and fusion.
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Affiliation(s)
- Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Kyle Morse
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Maximilian K Korsun
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - James Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Harvinder Sandhu
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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15
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Nassr A, Coric D, Pinter ZW, Sebastian AS, Freedman BA, Whiting D, Chahlavi A, Pirris S, Phan N, Meyer SA, Tahernia AD, Sandhu F, Deutsch H, Potts EA, Cheng J, Chi JH, Groff M, Anekstein Y, Steinmetz MP, Welch WC. Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1041-1053. [PMID: 38713762 DOI: 10.2106/jbjs.23.00719] [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: 05/09/2024]
Abstract
BACKGROUND The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown. METHODS In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score. Secondary outcomes included the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, Zurich Claudication Questionnaire (ZCQ), Short Form (SF)-12, radiographic parameters, surgical variables, and complications. RESULTS A total of 321 adult patients were randomized in a 2:1 fashion, with 219 patients assigned to undergo facet arthroplasty and 102 patients assigned to undergo fusion. Of these, 113 patients (51.6%) in the arthroplasty group and 47 (46.1%) in the fusion group who had either reached 24 months of postoperative follow-up or were deemed early clinical failures were included in the primary outcome analysis. The arthroplasty group had a higher proportion of patients who achieved composite clinical success than did the fusion group (73.5% versus 25.5%; p < 0.001), equating to a between-group difference of 47.9% (95% confidence interval, 33.0% to 62.8%). The arthroplasty group outperformed the fusion group in most patient-reported outcome measures (including the ODI, VAS back pain, and all ZCQ component scores) at 24 months postoperatively. There were no significant differences between groups in surgical variables or complications, except that the fusion group had a higher rate of developing symptomatic adjacent segment degeneration. CONCLUSIONS Among patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis, lumbar facet arthroplasty was associated with a higher rate of composite clinical success than fusion was at 24 months postoperatively. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- Carolinas Neurosurgery & Spine Associates, SpineFirst Atrium Health, Charlotte, North Carolina
| | | | | | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Ali Chahlavi
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | - Stephen Pirris
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | | | - Scott A Meyer
- Atlantic Neurosurgical Specialists, Altair Health, Morristown, New Jersey
| | | | - Faheem Sandhu
- MedStar Georgetown University Hospital, Washington DC
| | | | - Eric A Potts
- Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | | | - John H Chi
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Yoram Anekstein
- Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Michael P Steinmetz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William C Welch
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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16
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Sastry RA, Levy JF, Chen JS, Weil RJ, Oyelese AA, Fridley JS, Gokaslan ZL. Lumbar Decompression With and Without Fusion for Lumbar Stenosis With Spondylolisthesis: A Cost Utility Analysis. Spine (Phila Pa 1976) 2024; 49:847-856. [PMID: 38251455 DOI: 10.1097/brs.0000000000004928] [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: 09/16/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
STUDY DESIGN Markov model. OBJECTIVE To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA Rates of lumbar fusion have increased for all indications in the United States over the last 20 years. Recent randomized controlled trial data, however, have suggested comparable functional outcomes and lower reoperation rates for lumbar decompression and fusion as compared with DA in the treatment of lumbar stenosis with degenerative spondylolisthesis. MATERIALS AND METHODS A multistate Markov model was constructed from the US payer perspective of a hypothetical cohort of patients with lumbar stenosis with associated spondylolisthesis requiring surgery. Data regarding clinical improvement, costs, and reoperation were generated from contemporary randomized trial evidence, meta-analyses of recent prospective studies, and large retrospective cohorts. Base case, one-way sensitivity analysis, and probabilistic sensitivity analyses were conducted, and the results were compared with a WTP threshold of $100,000 (in 2022 USD) over a two-year time horizon. A discount rate of 3% was utilized. RESULTS The incremental cost and utility of DF relative to DA were $12,778 and 0.00529 aggregated quality adjusted life years. The corresponding incremental cost-effectiveness ratio of $2,416,281 far exceeded the willingness to pay threshold of $100,000. In sensitivity analysis, the results varied the most with respect to rate of improvement after DA, rate of improvement after lumbar decompression and fusion, and odds ratio of reoperation between the two groups. Zero percent of one-way and probabilistic sensitivity analyses achieved cost-effectiveness at the willingness-to-pay threshold. CONCLUSIONS Within the context of contemporary surgical data, DF is not cost-effective compared with DA in the surgical management of lumbar stenosis with associated spondylolisthesis over a two-year time horizon.
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Affiliation(s)
- Rahul A Sastry
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Joseph F Levy
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jia-Shu Chen
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Robert J Weil
- Department of Neurosurgery, Brain and Spine, Southcoast Health, Dartmouth, MA
| | - Adetokunbo A Oyelese
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jared S Fridley
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Ziya L Gokaslan
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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17
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Manoharan R, Cherry A, Raj A, Srikandarajah N, Xu M, Iorio C, Nielsen CJ, Rampersaud YR, Lewis SJ. Distal Lumbar Lordosis is Associated With Reoperation for Adjacent Segment Disease After Lumbar Fusion for Degenerative Conditions. Global Spine J 2024:21925682241262704. [PMID: 38874188 DOI: 10.1177/21925682241262704] [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: 06/15/2024] Open
Abstract
STUDY DESIGN A single centre retrospective review. OBJECTIVE Recent studies have suggested that distal lordosis (L4-S1, DL) remains constant across all pelvic incidence (PI) subgroups, whilst proximal lordosis (L1-L4, PL) varies. We sought to investigate the impact of post-operative DL on adjacent segment disease (ASD) requiring reoperation in patients undergoing lumbar fusion for degenerative conditions. METHODS Patients undergoing 1-3 level lumbar fusion with the two senior authors between 2007-16 were included. Demographic and radiographic data were recorded. Univariate, multivariate binary logistic regression, and Kaplan Meier survivorship analyses were performed. RESULTS 335 patients were included in the final analysis. Most had single (67%) or two (31%) level fusions. The mean follow-up was 64-month. Fifty-seven patients (17%) underwent reoperation for ASD at an average of 78-month post-operatively (R group). The R group had a significantly lower mean post-operative DL (27.3 vs 31.1 deg, P < .001) and mean PI (55.5 vs 59.2 deg, P < .05). On univariate analysis, patients with a post-operative DL of <35 deg had higher odds of reoperation for ASD than those with a post-operative DL of ≥35 deg (OR 2.7, P = .016). In the multivariate model, post-operative DL, low/average PI, and spondylolisthesis were all significantly associated with reoperation for ASD. CONCLUSION This study provides preliminary support to an association between post-operative distal lumbar lordosis and risk of reoperation for ASD in patients undergoing fusions for degenerative conditions. Further multicentre prospective study is needed to independently confirm this association and identify the impact of restoration of physiological distal lumbar lordosis on long term patient outcomes.
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Affiliation(s)
- Ragavan Manoharan
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ahmed Cherry
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Orthopedic Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aditya Raj
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Nisaharan Srikandarajah
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- The Walton Centre, Liverpool, L9 7LJ" and "Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mark Xu
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carlo Iorio
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Orthopaedic and Spine Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Yoga Raja Rampersaud
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
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18
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Berven S, Wang MY, Lin JH, Kakoty S, Lavelle W. Effects of liposomal bupivacaine on opioid use and healthcare resource utilization after outpatient spine surgery: a real-world assessment. Spine J 2024:S1529-9430(24)00258-4. [PMID: 38843956 DOI: 10.1016/j.spinee.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND CONTEXT Perioperative pain management affects cost and outcomes in elective spine surgery. PURPOSE This study investigated the association between liposomal bupivacaine (LB) and outpatient spine surgery outcomes, including perioperative, postoperative, and postdischarge opioid use and healthcare resource utilization. STUDY DESIGN This was a retrospective comparative study. PATIENT SAMPLE Eligibility criteria included adults with ≥6 months of continuous data before and after outpatient spine procedures including discectomy, laminectomy, or lumbar fusion. Patients receiving LB were matched 1:3 to patients receiving non-LB analgesia by propensity scores. OUTCOME MEASURES Outcomes included (1) opioid use in morphine milligram equivalents (MMEs) during the perioperative and postdischarge periods and (2) postdischarge readmission and emergency department (ED) visits up to 3 months after surgery. Generalized linear mixed-effects modeling with appropriate distributions was used for analysis. METHODS Deidentified data from the IQVIA linkage claims databases (2016-2019) were used for the analysis. This study was funded by Pacira BioSciences, Inc. RESULTS In total, 381 patients received LB and 1143 patients received non-LB analgesia. Baseline characteristics were well balanced after propensity score matching. The LB cohort used fewer MMEs versus the non-LB cohort before discharge (80 vs 132 MMEs [mean difference, -52 MMEs; p=.0041]). Following discharge, there was a nonsignificant reduction in opioid use in the LB cohort versus the non-LB cohort within 90 days (429 vs 480 MMEs [mean difference, -50 MMEs; p=.289]) and from >90 days to 180 days (349 vs 381 MMEs [mean difference, -31 MMEs; p=.507]). The LB cohort had significantly lower rates of ED visits at 2 months after discharge versus the non-LB cohort (3.9% vs 7.6% [odds ratio, 0.50; p=.015]). Postdischarge readmission rates did not differ between cohorts. CONCLUSIONS Use of LB for outpatient spine surgery was associated with reduced opioid use at the hospital and nonsignificant reduction in opioid use at all postoperative timepoints examined through 90 days after surgery versus non-LB analgesia. ED visit rates were significantly lower at 60 days after discharge. These findings support reduced cost and improved quality metrics in patients treated with LB versus non-LB analgesia for outpatient spine surgery.
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Affiliation(s)
- Sigurd Berven
- Department of Orthopaedic Surgery, University of California at San Francisco, 500 Parnassus Ave MU320W, San Francisco, CA 94143, USA
| | - Michael Y Wang
- Miller School of Medicine, Miami University, 1550 NW 10th Ave #118, Miami, FL 33136, USA
| | - Jennifer H Lin
- Pacira BioSciences, Inc., 5401 W Kennedy Blvd, Suite 890, Tampa, FL 33609, USA.
| | - Swapnabir Kakoty
- Pacira BioSciences, Inc., 5401 W Kennedy Blvd, Suite 890, Tampa, FL 33609, USA
| | - William Lavelle
- Upstate University Hospital, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
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19
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Dorsi MJ, Buchanan P, Vu C, Bhandal HS, Lee DW, Sheth S, Shumsky PM, Brown NJ, Himstead A, Mattie R, Falowski SM, Naidu R, Pope JE. Pacific Spine and Pain Society (PSPS) Evidence Review of Surgical Treatments for Lumbar Degenerative Spinal Disease: A Narrative Review. Pain Ther 2024; 13:349-390. [PMID: 38520658 PMCID: PMC11111626 DOI: 10.1007/s40122-024-00588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Interventional treatment options for the lumbar degenerative spine have undergone a significant amount of innovation over the last decade. As new technologies emerge, along with the surgical specialty expansion, there is no manuscript that utilizes a review of surgical treatments with evidence rankings from multiple specialties, namely, the interventional pain and spine communities. Through the Pacific Spine and Pain Society (PSPS), the purpose of this manuscript is to provide a balanced evidence review of available surgical treatments. METHODS The PSPS Research Committee created a working group that performed a comprehensive literature search on available surgical technologies for the treatment of the degenerative spine, utilizing the ranking assessment based on USPSTF (United States Preventative Services Taskforce) and NASS (North American Spine Society) criteria. RESULTS The surgical treatments were separated based on disease process, including treatments for degenerative disc disease, spondylolisthesis, and spinal stenosis. CONCLUSIONS There is emerging and significant evidence to support multiple approaches to treat the symptomatic lumbar degenerative spine. As new technologies become available, training, education, credentialing, and peer review are essential for optimizing patient safety and successful outcomes.
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Affiliation(s)
| | - Patrick Buchanan
- Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA
| | - Chau Vu
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
| | | | | | - Nolan J Brown
- Department of Neurosurgery, UC Irvine, Orange, CA, USA
| | | | | | | | - Ramana Naidu
- California Orthopedics and Spine, Novato, CA, USA
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20
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Abbatematteo JM, Giraldo JP, Williams GP, Lee JJ, DiDomenico JD, White MD, Lee KE, O'Neil LK, Cho SS, Rudy RF, Turner JD, Uribe JS. Anatomical Reduction of Spondylolisthesis Through Lateral Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: An Intraoperative Technical Note. World Neurosurg 2024; 189:70-76. [PMID: 38825313 DOI: 10.1016/j.wneu.2024.05.162] [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: 03/04/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Surgical management of lumbar spondylolisthesis requires neural decompression, stabilization, and alignment restoration. Minimally invasive spine approaches offer a wide variety of advantages for spondylolisthesis management. This intraoperative note describes the treatment of L4-L5 lumbar spondylolisthesis with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw fixation (PSF). METHODS The surgical technique for treating L4-L5 lumbar spondylolisthesis using a minimally invasive approach with LLIF and percutaneous PSF is described. This operative technique is illustrated with figures, and an intraoperative case example of its application is described. RESULTS LLIF with percutaneous PSF can be a safe, effective, and reliable option for treating lumbar spondylolisthesis when applied with appropriate surgical technique in a selected patient population. This technique is a valuable addition to the range of available spine surgical options. CONCLUSIONS LLIF with percutaneous PSF can be an effective technique for treating lumbar L4-L5 spondylolisthesis.
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Affiliation(s)
- Joseph M Abbatematteo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan P Giraldo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Gabriella P Williams
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jonathan J Lee
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael D White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Katriel E Lee
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Luke K O'Neil
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve S Cho
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
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21
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Yagi M, Yamamoto T, Iga T, Ogura Y, Suzuki S, Ozaki M, Takahashi Y, Tsuji O, Nagoshi N, Kono H, Ogawa J, Matsumoto M, Nakamura M, Watanabe K. Development and Validation of Machine Learning-Based Predictive Model for Prolonged Hospital Stay after Decompression Surgery for Lumbar Spinal Canal Stenosis. Spine Surg Relat Res 2024; 8:315-321. [PMID: 38868786 PMCID: PMC11165502 DOI: 10.22603/ssrr.2023-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction models lack accuracy and generalizability. Machine learning can improve accuracy by considering preoperative factors. This study aimed to develop and validate a machine learning-based model for estimating hospital stay duration following decompression surgery for LSS. Methods Data from 848 patients who underwent decompression surgery for LSS at three hospitals were examined. Twelve prediction models, using 79 preoperative variables, were developed for postoperative hospital stay estimation. The top five models were chosen. Fourteen models predicted prolonged hospital stay (≥14 days), and the most accurate model was chosen. Models were validated using a randomly divided training sample (70%) and testing cohort (30%). Results The top five models showed moderate linear correlations (0.576-0.624) between predicted and measured values in the testing sample. The ensemble of these models had moderate prediction accuracy for final length of stay (linear correlation 0.626, absolute mean error 2.26 days, standard deviation 3.45 days). The c5.0 decision tree model was the top predictor for prolonged hospital stay, with accuracies of 89.63% (training) and 87.2% (testing). Key predictors for longer stay included JOABPEQ social life domain, facility, history of vertebral fracture, diagnosis, and Visual Analogue Scale (VAS) of low back pain. Conclusions A machine learning-based model was developed to predict postoperative hospital stay after LSS decompression surgery, using data from multiple hospital settings. Numerical prediction of length of stay was not very accurate, although favorable prediction of prolonged stay was accomplished using preoperative factors. The JOABPEQ social life domain score was the most important predictor.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Tatsuya Yamamoto
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Takahito Iga
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Yoji Ogura
- Department of Orthopedic Surgery, Tachikawa Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Kono
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Jun Ogawa
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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22
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Rangwalla K, Filley A, El Naga A, Gendelberg D, Baldwin A, Maziad A, Arora A, Wague A, O'Donnell J, Chryssikos T, Kasir R, Shah J, Theologis A, Tan L, Mummaneni P, Alamin T, Berven SH. Degenerative lumbar spondylolisthesis: review of current classifications and proposal of a novel classification system. 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; 33:1762-1772. [PMID: 37543967 DOI: 10.1007/s00586-023-07818-x] [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: 11/05/2022] [Revised: 05/27/2023] [Accepted: 06/04/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS. METHODS The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each. Kappa values were calculated to assess the inter- and intraobserver reliability for each of the four components separately. RESULTS Interobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation was 0.94, 0.80, 0.87, and 1.00, respectively. Intraobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation were 0.91, 0.88, 0.87, and 0.97, respectively. CONCLUSION The UCSF DS classification system provides a novel framework for assessing DS based on radiographic and clinical parameters with established implications for surgical treatment. The almost perfect interobserver and intraobserver reliability observed for all components of this system demonstrates that it is simple and easy to use. In clinical practice, this classification may allow subclassification of similar patients into groups that may benefit from distinct treatment strategies, leading to the development of algorithms to help guide selection of an optimal surgical approach. Future work will focus on the clinical validation of this system, with the goal of providing for more evidence-based, standardized approaches to treatment and improved outcomes for patients with DS.
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Affiliation(s)
- Khuzaima Rangwalla
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Filley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ashraf El Naga
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - David Gendelberg
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Avionna Baldwin
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ali Maziad
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ayush Arora
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Aboubacar Wague
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer O'Donnell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rafid Kasir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jay Shah
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alekos Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Todd Alamin
- Department of Orthopaedic Spine Surgery, Stanford University, Redwood City, California, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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23
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Wang D, Chen X, Han D, Wang W, Kong C, Lu S. Radiographic predictors of reaching minimal clinically important difference following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis. 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; 33:1786-1795. [PMID: 38093000 DOI: 10.1007/s00586-023-08051-2] [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: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 06/18/2024]
Abstract
PURPOSE The present study aimed to (1) compare sagittal alignment between patients with degenerative lumbar spondylolisthesis (DLS) who reached or missed the minimal clinically important difference (MCID) for clinical outcomes following lumbar fusion surgery (LFS) and (2) identify radiographic predictors associated with MCID achievement in DLS patients. METHODS A total of 91 single-level DLS patients who underwent LFS and had a minimum of 1-year follow-up were enrolled in this study. The assessed radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), segmental lumbar lordosis (SLL), slip percentage, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis. Changes in radiographic parameters were determined by subtracting the preoperative value from the final follow-up measurement. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for both back and leg pain. MCID values were set at 10 points for ODI, 2.1 points for VAS back pain, and 2.8 points for VAS leg pain. Patients were assigned to the reached MCID (rMCID) and missed MCID (mMCID) groups based on the postoperative (post-op) recovery of clinical outcomes. RESULTS At the last follow-up, 68.1% (62/91), 72.5% (66/91), and 76.9% (70/91) of patients reached MCID for ODI, VAS back pain, and VAS leg pain, respectively. Concerning ODI, the rMCID group exhibited higher post-op LL (47.93° vs. 42.95°, P = 0.044), higher post-op SLL (17.08° vs. 14.41°, P = 0.032), higher post-op SS (34.46° vs. 30.63°, P = 0.027), higher ∆LL (5.90° vs. 2.44°, P = 0.017), higher ∆SLL (4.63° vs. - 1.03°, P < 0.001), higher ∆SS (4.76° vs. 1.23°, P = 0.002), lower post-op PT/PI (36.95% vs. 42.01%, P = 0.049), lower ∆PT (- 3.71° vs. 1.05°, P < 0.001), lower ∆PT/PI (- 7.45% vs. 1.97%, P < 0.001), and lower ∆PI-LL (- 5.43° vs. - 3.71°, P = 0.011) than the mMCID group. Regarding VAS back pain, the rMCID group showed higher post-op SLL (17.06° vs. 14.05°, P = 0.021), higher post-op SS (34.34° vs. 30.33°, P = 0.027), higher ∆SLL (3.93° vs. - 0.09°, P < 0.001), and lower ∆PT (- 2.91° vs. - 0.30°, P = 0.039) than the mMCID group. For VAS leg pain, higher ∆SLL (3.55° vs. 0.41°, P = 0.003) was observed in the rMCID group than in the mMCID group. Multivariate logistic regression analysis revealed that higher ∆SLL, higher ∆SS, and higher post-op SS were independent predictors for the achievement of MCID in patients with DLS. CONCLUSION DLS patients who reached MCID following LFS demonstrated improved post-op spinopelvic alignment. Higher ∆SLL, higher ∆SS, and higher post-op SS were the critical parameters associated with MCID achievement in patients with DLS.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
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24
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Wang D, Wang W, Han D, Muthu S, Cabrera JP, Hamouda W, Ambrosio L, Cheung JPY, Le HV, Vadalà G, Buser Z, Wang JC, Cho S, Yoon ST, Lu S, Chen X, Diwan AD. Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. 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; 33:1748-1761. [PMID: 38043128 DOI: 10.1007/s00586-023-08041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). METHODS The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. RESULTS Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. CONCLUSION While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Waeel Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt
- Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia.
- St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia.
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Setliff JC, Anderst WJ. A scoping review of human skeletal kinematics research using biplane radiography. J Orthop Res 2024; 42:915-922. [PMID: 38366965 DOI: 10.1002/jor.25806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 12/12/2023] [Indexed: 02/19/2024]
Abstract
Biplane radiography has emerged as the gold standard for accurately measuring in vivo skeletal kinematics during physiological loading. The purpose of this scoping review was to map the extent, range, and nature of biplane radiography research on humans from 2004 through 2022. A literature search was performed using the terms biplane radiography, dual fluoroscopy, dynamic stereo X-ray, and biplane videoradiography. All articles referenced in included publications were also assessed for inclusion. A secondary search was then performed using the names of the most frequently appearing principal investigators among included papers. A total of 379 manuscripts were identified and included. The first studies published in 2004 focused on the native knee, followed by studies of the ankle joint complex in 2006, the shoulder in 2007, and the spine in 2008. Nearly half (180, 47.5%) of all manuscripts investigated knee kinematics. The average number of publications increased from 21.6 per year from 2012 to 2017 to 34.6 per year from 2017 to 2022. The average number of participants per study was 16, with a range from 1 to 101. A total of 90.2% of studies featured cohorts of 30 or less. The most prolific research groups for each joint were: Mass General Hospital (lumbar spine and knee), Henry Ford Hospital (shoulder), the University of Utah (ankle and hip), The University of Pittsburgh (cervical spine), and Brown University (hand/wrist/elbow). Future advancements in biplane radiography research are dependent upon increased availability of these imaging systems, standardization of data collection protocols, and the development of automated approaches to expedite data processing.
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Affiliation(s)
- Joshua C Setliff
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William J Anderst
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Jia H, Zhang Z, Qin J, Bao L, Ao J, Qian H. Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials. Int J Surg 2024; 110:3050-3059. [PMID: 38446872 PMCID: PMC11093486 DOI: 10.1097/js9.0000000000001228] [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: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear. MATERIALS AND METHODS The authors searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until 01 November 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions [nonsurgical (NS), decompression only (DO), decompression plus fusion without internal fixation (DF), decompression plus fusion with internal fixation (DFI), endoscopic decompression plus fusion (EDF), endoscopic decompression (ED), and circumferential fusion (360F)] were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed. RESULTS Data involving 3273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1 and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores. CONCLUSIONS Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.
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Affiliation(s)
| | | | | | | | - Jun Ao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Hu Qian
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
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Mani K, Kleinbart E, Goldman SN, Golding R, Gelfand Y, Murthy S, Eleswarapu A, Yassari R, Fourman MS, Krystal J. Projections of Single-level and Multilevel Spinal Instrumentation Procedure Volume and Associated Costs for Medicare Patients to 2050. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00011. [PMID: 38743853 PMCID: PMC11095963 DOI: 10.5435/jaaosglobal-d-24-00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Instrumented spinal fusions can be used in the treatment of vertebral fractures, spinal instability, and scoliosis or kyphosis. Construct-level selection has notable implications on postoperative recovery, alignment, and mobility. This study sought to project future trends in the implementation rates and associated costs of single-level versus multilevel instrumentation procedures in US Medicare patients aged older than 65 years in the United States. METHODS Data were acquired from the Centers for Medicare & Medicaid Services from January 1, 2000, to December 31, 2019. Procedure costs and counts were abstracted using Current Procedural Terminology codes to identify spinal level involvement. The Prophet machine learning algorithm was used, using a Bayesian Inference framework, to generate point forecasts for 2020 to 2050 and 95% forecast intervals (FIs). Sensitivity analyses were done by comparing projections from linear, log-linear, Poisson and negative-binomial, and autoregressive integrated moving average models. Costs were adjusted for inflation using the 2019 US Bureau of Labor Statistics' Consumer Price Index. RESULTS Between 2000 and 2019, the annual spinal instrumentation volume increased by 776% (from 7,342 to 64,350 cases) for single level, by 329% (from 20,319 to 87,253 cases) for two-four levels, by 1049% (from 1,218 to 14,000 cases) for five-seven levels, and by 739% (from 193 to 1,620 cases) for eight-twelve levels (P < 0.0001). The inflation-adjusted reimbursement for single-level instrumentation procedures decreased 45.6% from $1,148.15 to $788.62 between 2000 and 2019, which is markedly lower than for other prevalent orthopaedic procedures: total shoulder arthroplasty (-23.1%), total hip arthroplasty (-39.2%), and total knee arthroplasty (-42.4%). By 2050, the number of single-level spinal instrumentation procedures performed yearly is projected to be 124,061 (95% FI, 87,027 to 142,907), with associated costs of $93,900,672 (95% FI, $80,281,788 to $108,220,932). CONCLUSIONS The number of single-level instrumentation procedures is projected to double by 2050, while the number of two-four level procedures will double by 2040. These projections offer a measurable basis for resource allocation and procedural distribution.
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Affiliation(s)
- Kyle Mani
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Emily Kleinbart
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Samuel N. Goldman
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Regina Golding
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Yaroslav Gelfand
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Saikiran Murthy
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Ananth Eleswarapu
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Reza Yassari
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Mitchell S. Fourman
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
| | - Jonathan Krystal
- From the Albert Einstein College of Medicine, Bronx, NY (Mr. Mani, Ms. Kleinbart, Mr. Goldman, Ms. Golding); the Department of Neurological Surgery (Dr. Gelfand, Dr. Murthy, Dr. Yassari) and the Department of Orthopaedic Surgery (Dr. Eleswarapu, Dr. Fourman, Dr. Krystal), Montefiore Einstein, Bronx, NY
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Shahrestani S, Reardon T, Brown NJ, Kuo CC, Gendreau J, Singh R, Patel NA, Chou D, Chan AK. Developing Mixed-Effects Models to Compare the Predictive Ability of Various Comorbidity Indices in a Contemporary Cohort of Patients Undergoing Lumbar Fusion. Neurosurgery 2024; 94:711-720. [PMID: 37855622 DOI: 10.1227/neu.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE As incidence of operative spinal pathology continues to grow, so do the rates of lumbar spinal fusion procedures. Comorbidity indices can be used preoperatively to predict potential complications. However, there is a paucity of research defining the optimal comorbidity indices in patients undergoing spinal fusion surgery. We aimed to use modeling strategies to evaluate the predictive validity of various comorbidity indices and combinations thereof. METHODS Patients who underwent spinal fusion were queried using data from the Nationwide Readmissions Database for the years 2016 through 2019. Using comorbidity indices as predictor variables, receiver operating characteristic curves were developed for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 30-day readmission. RESULTS A total of 750 183 patients were included. Nonroutine discharges occurred in 161 077 (21.5%) patients. The adjusted all-payer cost for the procedure was $37 616.97 ± $27 408.86 (top quartile: $45 409.20), and the length of stay was 4.1 ± 4.4 days (top quartile: 8.1 days). By comparing receiver operating characteristics of various models, it was found that models using Frailty + Elixhauser Comorbidity Index (ECI) as the primary predictor performed better than other models with statistically significant P -values on post hoc testing. However, for prediction of mortality, the model using Frailty + ECI was not better than the model using ECI alone ( P = .23), and for prediction of all-payer cost, the ECI model outperformed the models using frailty alone ( P < .0001) and the model using Frailty + ECI ( P < .0001). CONCLUSION This investigation is the first to use big data and modeling strategies to delineate the relative predictive utility of the ECI and Johns Hopkins Adjusted Clinical Groups comorbidity indices for the prognostication of patients undergoing lumbar fusion surgery. With the knowledge gained from our models, spine surgeons, payers, and hospitals may be able to identify vulnerable patients more effectively within their practice who may require a higher degree of resource utilization.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles , California , USA
- Department of Medical Engineering, California Institute of Technology, Pasadena , California , USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville , Kentucky , USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange , California , USA
| | - Cathleen C Kuo
- Department of Neurological Surgery, University at Buffalo, Buffalo , New York , USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore , Maryland , USA
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale , Arizona , USA
| | - Neal A Patel
- School of Medicine, Mercer University, Savannah , Georgia , USA
| | - Dean Chou
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York , New York , USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York , New York , USA
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Dong W, Tang Y, Lei M, Ma Z, Zhang X, Shen J, Hao J, Jiang W, Hu Z. The effect of perioperative sequential application of multiple doses of tranexamic acid on postoperative blood loss after PLIF: a prospective randomized controlled trial. Int J Surg 2024; 110:2122-2133. [PMID: 38215261 PMCID: PMC11020010 DOI: 10.1097/js9.0000000000001083] [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: 08/08/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Tranexamic acid (TXA) has been utilized in spinal surgery to effectively reduce intraoperative blood loss (IBL) and allogeneic blood transfusion rates. However, the traditional TXA regimen might last the entire duration of hyperfibrinolysis caused by surgical trauma, resulting in its limited ability to reduce postoperative blood loss (PBL). Therefore, the aim of this study was to investigate the effectiveness of perioperative sequential administration of multiple doses of TXA in reducing PBL in patients who underwent posterior lumbar interbody fusion (PLIF). METHODS From October 2022 to June 2023, 231 patients who were diagnosed with lumbar degenerative disease and scheduled to undergo PLIF were prospectively enrolled in the present study. The patients were randomly divided into three groups. Moreover, all patients received an intravenous injection of TXA at a dose of 15 mg/kg 15 min before the surgical skin incision. Patients in Group A received a placebo of normal saline after surgery, while patients in Group B received three additional intravenous injections of TXA at a dose of 15 mg/kg every 24 h. Patients in Group C received three additional intravenous injections of TXA at a dose of 15 mg/kg every 5 h. The primary outcome measure was PBL. In addition, this study assessed total blood loss (TBL), IBL, routine blood parameters, liver and kidney function, coagulation parameters, fibrinolysis indexes, inflammatory indicators, drainage tube removal time (DRT), length of hospital stay (LOS), blood transfusion rate, and incidence of complications for all subjects. RESULTS The PBL, TBL, DRT, and LOS of Group B and Group C were significantly lower than those of Group A ( P <0.05). The level of D-dimer (D-D) in Group C was significantly lower than that in Group A on the first day after the operation ( P =0.002), and that in Group B was significantly lower than that in Group A on the third day after the operation ( P =0.003). The interleukin-6 levels between the three groups from 1 to 5 days after the operation were in the order of Group A > Group B > Group C. No serious complications were observed in any patient. The results of multiple stepwise linear regression analysis revealed that PBL was positively correlated with incision length, IBL, smoking history, history of hypertension, preoperative fibrinogen degradation product level, and blood transfusion. It was negatively correlated with preoperative levels of fibrinogen, red blood cells, blood urea nitrogen, and age. Compared to female patients, male patients had an increased risk of PBL. Finally, the incidence of PBL was predicted. CONCLUSIONS Sequential application of multiple doses of TXA during the perioperative period could safely and effectively reduce PBL and TBL, shorten DRT and LOS, reduce postoperative D-D generation, and reduce the postoperative inflammatory response. In addition, this study provided a novel prediction model for PBL in patients undergoing PLIF.
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Affiliation(s)
- Wei Dong
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Yuchen Tang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Miao Lei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Zhaoxin Ma
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Xiaojun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Jieliang Shen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Jie Hao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Wei Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
| | - Zhenming Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University
- Department of Orthopedics Surgery, University-Town Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Kurz E, Schenk P, Brakopp F, Diers M, Klingel O, Bone S, Meisel HJ, Delank KS, Ullrich BW. Muscle activity and rehabilitation in spinal stenosis (MARSS) after conservative therapy and surgical decompression with or without fusion: Protocol for a partially randomized patient preference trial on rehabilitation timing. Contemp Clin Trials Commun 2024; 38:101273. [PMID: 38425423 PMCID: PMC10904237 DOI: 10.1016/j.conctc.2024.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/07/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
Background Patients affected by lumbar spinal stenosis (LSS) suffer from a multifactorial degeneration of the lumbar spine resulting in narrowing of the neuroforamina and spinal canal, leading to various functional limitations. It remains unclear whether LSS patients after surgery would benefit from early post-operative rehabilitation, or if a delayed rehabilitation would be more advantageous. The purpose of this partially randomized patient preference trial is to evaluate the impact of post-operative rehabilitation timing as well as surgical intervention type on psychometric properties and functional outcomes in patients with LSS. Methods Data for this patient preference trial are collected before and after surgical (decompression only or decompression and fusion) and rehabilitative interventions as well as six, 12 and 24 months after completing rehabilitation. The study participants are patients diagnosed with LSS who are at least 18 years old. After a medical check-up, participants will complete patient-reported outcome measures (PAREMO-20, SIBAR, FREM-8, SF-12, SFI, ODI) and different functional assessments (functional reach test, loaded reach test, handgrip strength, standing balance control, 6-min walk test). Ethics and dissemination The results of this study will be published through peer-reviewed publications and scientific contributions at national and international conferences. This research has been approved by the Institutional Review Board of Martin Luther University Halle-Wittenberg (reference number: 2022-128).
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Affiliation(s)
- Eduard Kurz
- Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle (Saale), Germany
| | - Florian Brakopp
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle (Saale), Germany
| | - Moritz Diers
- Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Oliver Klingel
- Saline Rehabilitationsklinik, Mansfelder Str. 52, 06108, Halle (Saale), Germany
| | - Stefan Bone
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle (Saale), Germany
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Bernhard W. Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle (Saale), Germany
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Liu R, He T, Wu X, Tan W, Yan Z, Deng Y. Biomechanical response of decompression alone in lower grade lumbar degenerative spondylolisthesis--A finite element analysis. J Orthop Surg Res 2024; 19:209. [PMID: 38561837 PMCID: PMC10983632 DOI: 10.1186/s13018-024-04681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis. PURPOSE Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS). METHODS Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment. RESULTS The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models. CONCLUSION Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models.
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Affiliation(s)
- Renfeng Liu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Tao He
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Xin Wu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Wei Tan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Zuyun Yan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Youwen Deng
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China.
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Hareni N, Ebrahimnia S, Rosengren BE, Karlsson MK. Recovery pattern after decompression of central lumbar spinal stenosis: a prospective observational cohort study. J Orthop Surg Res 2024; 19:200. [PMID: 38528550 DOI: 10.1186/s13018-024-04614-1] [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: 01/02/2024] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Detailed preoperative information is associated with superior outcomes. We aimed to describe the recovery pattern after decompression of central lumbar spinal stenosis (CLSS). METHODS 50 patients aged 51-85 years who underwent decompression without fusion due to CLSS were followed from before to after surgery (post-op day 1, 7, and 14). Back and leg pain were evaluated using the Numeric Rating Scale (NRS; 0 = no pain 0, 10 = worst pain) and quality of life using the EuroQol-5D index (0 = death, 1 = best), and EQ-5D-visual analogue scale (VAS; 0 = worst, 100 = best). RESULTS NRS leg pain was reduced from preoperative to first postoperative day by 5.2 (6.1, 4.3) (mean (95%CI)], and NRS back pain from postoperative day 1-7 by 0.6 (1.2, 0.03) and from day 7 to 14 by 0.7 (1.3, 0.2)]. In contrast, EQ-5D index increased from preoperative to first postoperative day by 0.09 (0.06, 0.13) and from day 1 to 7 by 0.05 (0.02,0.08), and EQ-5D VAS from preoperative to first postoperative day by 13.7 (9.1, 18.3) and from day 1 to 7 by 6.0 (2.0, 10.0). After two weeks, 51% of the patients had improved above the minimal clinically important difference (MCID) in back pain and 71% in leg pain. CONCLUSIONS Patients scheduled for decompression due to CLSS should be informed that improvement in leg pain and quality of life in general can be expected within one day of surgery, that quality of life improves a little further in the first postoperative week, and that back pain improves in the first 2 postoperative weeks. In most patients, decompression without fusion due to CLSS seems to achieve clinically relevant improvement within 2 weeks.
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Affiliation(s)
- Niyaz Hareni
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
- Department of Orthopaedics, Varberg Hospital, Träslövsvägen 68, 432 37, Varberg, Sweden.
| | - Soheil Ebrahimnia
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Atallah O, Alrefaie K, Al Krinawe Y. Crucial trials in neurosurgery: a must-know for every neurosurgeon. Neurosurg Rev 2024; 47:126. [PMID: 38512522 PMCID: PMC10957582 DOI: 10.1007/s10143-024-02358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Street. Nr. 1, 30625, Hannover, Germany.
| | - Khadeja Alrefaie
- Faculty of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Yazeed Al Krinawe
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Street. Nr. 1, 30625, Hannover, Germany
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Capo G, Calvanese F, Vandenbulcke A, Zaed I, Di Carlo DT, Cao R, Barrey CY. Lateral-PLIF for spinal arthrodesis: concept, technique, results, complications, and outcomes. Acta Neurochir (Wien) 2024; 166:123. [PMID: 38451339 DOI: 10.1007/s00701-024-06024-y] [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: 11/12/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which we then evaluated through a prospective consecutive series of patients. METHODS All adult patients treated at our institute with single or double level Lateral-PLIF for lumbar degenerative disease from January to December 2017 were prospectively collected. Exclusion criteria were patients < 18 years of age, traumatic patients, active infection, or malignancy, as well as unavailability of clinical and/or radiological follow-up data. The technique consists of insert the cages bilaterally through the transition zone between the central canal and the intervertebral foramen, just above the lateral recess. Pre- and postoperative (2 years) questionnaires and phone interviews (4 years) assessed pain and functional outcomes. Data related to the surgical procedure, postoperative complications, and radiological findings (1 year) were collected. RESULTS One hundred four patients were selected for the final analysis. The median age was 58 years and primary symptoms were mechanical back pain (100, 96.1%) and/or radicular pain (73, 70.2%). We found a high fusion rate (95%). A statistically significant improvement in functional outcome was also noted (ODI p < 0.001, Roland-Morris score p < 0.001). Walking distance increased from 812 m ± 543 m to 3443 m ± 712 m (p < 0.001). Complications included dural tear (6.7%), infection/wound dehiscence (4.8%), and instrument failure (1.9%) but no neurological deterioration. CONCLUSIONS Lateral-PLIF is a safe and effective technique for lumbar interbody fusion and may be considered for further comparative study validation with other techniques before extensive use to treat lumbar degenerative disease.
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Affiliation(s)
- Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Calvanese
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France.
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Alberto Vandenbulcke
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Ismail Zaed
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Cao
- Department of Neuroradiology, Pierre Wertheimer Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Cédric Y Barrey
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts Et Metiers ParisTech, 153 Boulevard de L'Hôpital, 75013, Paris, France
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Zhou Q, Sun X, Wang B, Zhu Z, Qiu Y. How Does the Slump Sitting Radiograph Increase Proportion of Segmental Instability and Kyphotic Alignment of Lumbar Degenerative Spondylolisthesis? Orthop Surg 2024; 16:551-558. [PMID: 38214017 PMCID: PMC10925499 DOI: 10.1111/os.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Clinical and radiographic degenerative spondylolisthesis (CARDS) classification was proposed to differentiate homogenous lumbar degenerative spondylolisthesis (LDS) subgroups. The sitting radiograph exhibited lumbar malalignment with maximum lumbar kyphosis, intervertebral kyphosis, and spondylolisthesis.This study aimed to assess the sitting radiograph for distribution of clinical and radiographic degenerative spondylolisthesis classification, and to elucidate its significance for exhibiting kyphotic alignment (CARDS type D) and segmental instability. METHODS A cohort of 101 patients with symptomatic lumbar degenerative spondylolisthesis (LDS) between September 2018 and December 2020 were recruited. The distribution and relibility of CARDS classification with or without sitting radiograph was assessed. The translational and angular range of motion and segmental instability was also evaluated. Univariate analysis of variance was used for multiple groups, and the least significant difference for two groups. Kappa consistency test of intrarater and interrater was evaluated for CARDS classification with or without sitting radiograph. Chi-square test was used to compare paried categorical data. RESULTS Utility of sitting radiographs for CARDS classification revealed higher percentage of type D than that without the sitting radiograph (p < 0.001). The sitting radiograph revealed a larger slip distance than the flexion radiograph (p = 0.003), as well as a lower slip angle than flexion radiograph (p < 0.001). The sitting-supine modality demonstrated the largest translational range of motion compared to the sitting-extension (p < 0.001) and flexion-extension modalities (p < 0.001). The sitting-supine modality showed larger angular range of motion than the flexion-extension modality (p < 0.001). The percentage of flexion, extension, upright, supine, and sitting radiograph to identify translational instability was higher than that without sitting radiograph (p < 0.001), as well as taking angular motion ≥10° as an additional criterion for segmental instability (p < 0.001). CONCLUSION The CARDS classification was reliable for LDS. The sitting radiograph showed maximal slip distance and kyphotic slip angle. Application of the sitting radiograph was necessary for evaluating segmental instability and kyphotic alignment of LDS.
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Affiliation(s)
- Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [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: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Turcotte JJ, Brennan JC, Rana P, Johnson AH, Patton C. Outcomes in Lumbar Fusion Patients Stratified by the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification System. Cureus 2024; 16:e54177. [PMID: 38496088 PMCID: PMC10941802 DOI: 10.7759/cureus.54177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective The Meyerding classification system remains the most common classification system for spondylolisthesis based on the percentages of vertebral translation. However, the majority of patients with degenerative disease fall into Grade 1, limiting its utility in this subset of patients. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system provides a simple radiographic framework for classifying degenerative lumbar spondylolisthesis (DLS) patients by incorporating disc height, kyphosis, and anterior translation. The purpose of this study was to evaluate how clinical characteristics, treatments, and outcomes vary across different CARDS groups in patients undergoing one- or two-level lumbar fusion for DLS. Methods The patients were classified into one of the following four CARDS groups - Type A: advanced disc space collapse with no evidence of kyphosis; Type B: partially preserved disc space with less than 5.0 mm of translation; Type C: partially preserved disc space with greater than 5.0 mm of translation; and Type D: kyphotic alignment. Univariate analyses were performed to compare demographics, symptoms, clinical outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) physical (PH) and mental health (MH) scores across groups. Results Ninety-one patients were included in the study. Based on the CARDS classification, there were three (3%) Type A patients, 25 (28%) Type B, 58 (64%) Type C, and five (5%) Type D. No significant differences in baseline demographics, symptom duration, or PROMIS scores were observed across groups. Interbody utilization varied, ranging from 19% in CARDS C (n=11) to 60% in CARDS B (n=15) and D (n=3) patients (p=0.005). Thirty-day clinical outcomes were similar across groups. At an average follow-up of 8.9 months, improvements in PROMIS PH and MH scores and rates of clinically significant improvement were similar across groups. Conclusions Based on our findings, patients undergoing lumbar fusion for DLS present with similar demographic and clinical characteristics and experience similar clinical and patient-reported outcomes when stratified using the CARDS classification system. Posterolateral fusion (PLF) can be effective for various radiographic presentations of DLS. Further research is warranted to assess the utility of CARDS in preoperative planning.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Chad Patton
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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Ikeda N, Yokoyama K, Ito Y, Tanaka H, Yamada M, Sugie A, Takami T, Wanibuchi M, Kawanishi M. Factors influencing slippage after microsurgical single level lumbar spinal decompression surgery - Are the psoas and multifidus muscles involved? Acta Neurochir (Wien) 2024; 166:26. [PMID: 38252278 DOI: 10.1007/s00701-024-05924-3] [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: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients. METHODS Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5 years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2 mm was assessed on the last follow-up X-ray. RESULTS We included 95 patients with average age and follow-up periods of 69 ± 8.2 years and 7.51 ± 2.58 years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression. CONCLUSION Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.
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Affiliation(s)
- Naokado Ikeda
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan.
| | - Kunio Yokoyama
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Akira Sugie
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Toshihiro Takami
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
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Xu D, Shu W, Lian L, Jiang W, Hu X, Gan K, Ma W. The clinical effect of unilateral decompressive laminectomy plus fusion with unilateral biportal endoscopic technique for single level lumbar spinal stenosis. Asian J Surg 2024:S1015-9584(24)00065-4. [PMID: 38246788 DOI: 10.1016/j.asjsur.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to compare and analyze the effectiveness of unilateral biportal endoscopic (UBE) decompressive laminectomy plus fusion and microscope-assisted open decompressive laminectomy plus fusion. METHODS A total of 143 patients with lumbar spinal stenosis were enrolled in this study between March 2020 and February 2021 with a minimum 2 years follow-up visit to our hospital. Sixty-five patients underwent the unilateral biportal endoscopic technique and were assigned to the UBE group, and the remaining 78 patients with microscope assistant were assigned to the Microscope group. The baseline characteristics, clinical outcomes, and radiological data were retrospectively collected and analyzed, as well as Clinical outcomes, radiological data and complications. RESULTS There were no significant differences between the two groups in terms of baseline characteristics (P > 0.05). The UBE group was demonstrated to be significantly superior in CRP, drainage, blood loss, treatment cost and Hospital stay than the Microscope group (P < 0.05), whereas a significant longer operation time was observed (P < 0.05). The VAS-B, ODI, and JOA-L scores of the UBE group at 1 year follow-up were significantly greater than those of the Microscope group (P < 0.05). Regarding radiological data, there were no significant differences in the section area of the spinal canal and fusion grade between the two groups (P > 0.05). CONCLUSION In view of the satisfactory clinical outcomes of patients and notable decompression at the stenosed segment, UBE is a feasible, minimally invasive technique for single level lumbar canal stenosis.
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Affiliation(s)
- Dingli Xu
- Medical School, Ningbo University, Ningbo, 315100, Zhejiang, China
| | - Wubin Shu
- Ningbo Yinzhou No. 2 Hospital, Ningbo, 315100, Zhejiang, China
| | - Leidong Lian
- Medical School, Ningbo University, Ningbo, 315100, Zhejiang, China
| | - Weiyu Jiang
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China
| | - Xudong Hu
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China
| | - Kaifeng Gan
- The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315100, Zhejiang, China.
| | - Weihu Ma
- Ningbo No.6 Hospital, Ningbo, 315100, Zhejiang, China.
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Kosterhon M, Müller A, Rockenfeller R, Aiyangar AK, Gruber K, Ringel F, Kantelhardt SR. Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis. Front Bioeng Biotechnol 2024; 11:1281119. [PMID: 38260753 PMCID: PMC10801739 DOI: 10.3389/fbioe.2023.1281119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases. Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality. Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior-posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM. Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications.
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Affiliation(s)
- M. Kosterhon
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - A. Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Mathematics and Natural Science, Institute of Sports Science, University Koblenz, Koblenz, Germany
| | - R. Rockenfeller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Department of Mathematics and Natural Science, Mathematical Institute, University Koblenz, Koblenz, Germany
| | - A. K. Aiyangar
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Faculty of Engineering and Sciences, University of Adolfo Ibanez, Vina del Mar, Chile
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - K. Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
| | - F. Ringel
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - S. R. Kantelhardt
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
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Chauhan D, Ahmad HS, Hamade A, Yang AI, Wathen C, Ghenbot Y, Mannam S, Subtirelu R, Bashti M, Wang MY, Basil G, Yoon JW. Determining Differences in Perioperative Functional Mobility Patterns in Lumbar Decompression Versus Fusion Patients Using Smartphone Activity Data. Neurosurgery 2024:00006123-990000000-01010. [PMID: 38169310 DOI: 10.1227/neu.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences. METHODS Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch. RESULTS Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated. CONCLUSION Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Hamade
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sai Mannam
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Subtirelu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Malek Bashti
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Michael Y Wang
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Gregory Basil
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Javeed S, Benedict B, Yakdan S, Saleem S, Zhang JK, Botterbush K, Frumkin MR, Hardi A, Neuman B, Kelly MP, Steinmetz MP, Piccirillo JF, Goodin BR, Rodebaugh TL, Ray WZ, Greenberg JK. Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2348565. [PMID: 38277149 PMCID: PMC10818221 DOI: 10.1001/jamanetworkopen.2023.48565] [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: 07/01/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Comorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive. Objective To investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery. Data Sources A systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023. Study Selection Included studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included. Data Extraction and Synthesis All data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity. Main Outcomes and Measures The primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations. Results Of the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, -0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, -0.52 [95% CI, -0.62 to -0.41]; I2 = 89%; P < .001), which remained worse postoperatively (SMD, -0.52 [95% CI, -0.75 to -0.28]; I2 = 98%; P < .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance. Conclusions and Relevance Results of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.
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Affiliation(s)
- Saad Javeed
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Salim Yakdan
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Samia Saleem
- Department of Musculoskeletal Research, Washington University, St Louis, Missouri
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Kathleen Botterbush
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Madelyn R. Frumkin
- Department of Psychology and Brain Sciences, Washington University, St Louis, Missouri
| | - Angela Hardi
- Becker Medical Library, Washington University, St Louis, Missouri
| | - Brian Neuman
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri
| | - Michael P. Kelly
- Department of Orthopedic Surgery, Rady Children’s Hospital, University of California, San Diego, San Diego
| | | | - Jay F. Piccirillo
- Department of Otolaryngology, Washington University, St Louis, Missouri
| | - Burel R. Goodin
- Department of Anesthesiology, Washington University, St Louis, Missouri
| | - Thomas L. Rodebaugh
- Department of Psychology and Brain Sciences, Washington University, St Louis, Missouri
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University, St Louis, Missouri
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
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Lafuente J, Patino JD, Capo L. Management of Low and High Grades Spondylolisthesis. Adv Tech Stand Neurosurg 2024; 49:51-72. [PMID: 38700680 DOI: 10.1007/978-3-031-42398-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Spondylolisthesis is defined as the displacement or misalignment of the vertebral bodies one on top of the other. It comes from the Greek spondlylos, which means vertebra, and olisthesis, which means sliding on a slope. The nomenclature used to refer to spondylolisthesis consists of the following elements: vertebral segment (vertebrae involved), degree of sliding of one vertebral body over the other, the position of the upper vertebral body with respect to the lower one (anterolisthesis/retrolisthesis), and finally the etiology [1].
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Affiliation(s)
- Jesus Lafuente
- Associate Profedsor Neurosurgery, Director Spine center Hospital del Mar, Barcelona, Spain
| | | | - Lucas Capo
- Fellow Neurosurgeon Hospital de Sant Pau, Barcelona, Spain
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Honarpisheh P, Parker SL, Conner CR, Anjum S, Stark JR, Quinn JC, Caridi JM. 20-year Inflation-Adjusted Medicare Reimbursements (Years: 2000-2020) For Common Lumbar and Cervical Degenerative Disc Disease Procedures. Global Spine J 2024; 14:211-218. [PMID: 35609345 PMCID: PMC10676153 DOI: 10.1177/21925682221100173] [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: 11/16/2022] Open
Abstract
OBJECTIVE Reimbursement trends for common procedures have persistently declined over the past 2 decades. Spinal instrumentational and fusion procedures are increasingly utilized and have increased in clinical complexity, yet longitudinal inflation-adjusted data for Medicare reimbursements of these procedures have not been evaluated. METHODS The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements for the 5 most common spinal procedures and associated instrumentations from 2000-2020. Current Procedural Terminology (CPT) codes include 22551, 22600, 22633, 63030, and 63047 as well as instrumentation CPT codes 22840 and 22842-6. The nominal values were adjusted for inflation according to the latest consumer price index (U.S. Bureau of Labor Statistics; reported as 2020 USD) and used to calculate average annual percent changes and compound annual growth rates (CAGRs) in reimbursements. RESULTS After inflation adjustment, the physician fee reimbursement decreased by 11.05% ± 8.46% (mean ± s.d., from $2,009.89 in 2011 to $1,787.85 in 2020) for anterior cervical discectomy and fusion (ACDF), 28.38% ± 8.42% (from $1,889.38 in 2000 to $1,353.14 in 2020) for posterior cervical fusion, 7.85% ± 8.20% (from $2,111.20 in 2012 to $1,945.49 in 2020) for transforaminal lumbar interbody fusion (TLIF), 28.17% ± 13.88% (from $1,421.78 in 2000 to $1,021.22 in 2020) for lower back disc surgery, and 31.88% ± 8.22% (from $1,700.38 in 2000 to $1,158.25 in 2020) for lumbar laminectomy. Instrumentation reimbursements showed an average decrease of 33.43% ± 8.4% over this period. Average CAGR was -1.7% ± .41% for procedures and -2.02% ± .14% for instrumentation. CONCLUSION Our analysis reveals a persistent decline in reimbursement rates of the most common spine procedures and instrumentation since the year 2000. If unaddressed, this trend can serve as a substantial disincentive for physicians to perform these procedures and can significantly limit access to spinal care at the population level.
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Affiliation(s)
- Pedram Honarpisheh
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
- UTHealth Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha L Parker
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sami Anjum
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jessica R Stark
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John C Quinn
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John M Caridi
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Antonioli E, Tavares Malheiro D, Damazio Teich V, Dias Paião I, Cendoroglo Neto M, Lenza M. Cost-effectiveness of a second opinion program on spine surgeries: an economic analysis. BMC Health Serv Res 2023; 23:1441. [PMID: 38115007 PMCID: PMC10731842 DOI: 10.1186/s12913-023-10405-x] [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: 04/13/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In this study we proposed a new strategy to measure cost-effectiveness of second opinion program on spine surgery, using as measure of effectiveness the minimal important change (MIC) in the quality of life reported by patients, including the satisfaction questionnaire regarding the treatment and direct medical costs. METHODS Retrospective analysis of patients with prior indication for spine surgery included in a second opinion program during May 2011 to May 2019. Treatment costs and outcomes were compared considering each patients' recommended treatment before and after the second opinion. Costs were measured under the perspective of the hospital, including hospital stay, surgical room, physician and staff fees and other costs related to hospitalization when surgery was performed and physiotherapy or injection costs when a conservative treatment was recommended. Reoperation costs were also included. For comparison analysis, we used data based on our clinical practice, using data from patients who underwent the same type of surgical procedure as recommended by the first referral. The measure of effectiveness was the percentage of patients who achieved the MIC in quality of life measured by the EQ-5D-3 L 2 years after starting treatment. An incremental cost-effectiveness ratio (ICER) was calculated. RESULTS Based upon the assessment of 1,088 patients that completed the entire second opinion process, conservative management was recommended for 662 (60.8%) patients; 49 (4.5%) were recommended to injection and 377 (34.7%) to surgery. Complex spine surgery, as arthrodesis, was recommended by second opinion in only 3.7% of cases. The program resulted in financial savings of -$6,705 per patient associated with appropriate treatment indication, with an incremental effectiveness of 0.077 patients achieving MIC when compared to the first referral, resulting in an ICER of $-87,066 per additional patient achieving the MIC, ranging between $-273,016 and $-41,832. CONCLUSION After 2 years of treatment, the second opinion program demonstrated the potential for cost-offsets associated with improved quality of life.
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Affiliation(s)
- Eliane Antonioli
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil.
| | - Daniel Tavares Malheiro
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Vanessa Damazio Teich
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Isabela Dias Paião
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Miguel Cendoroglo Neto
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
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46
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Kim DC, Laskay N, Alcala C, Schwender J. Minimally Invasive Decompression With Noninstrumented Facet Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Stenosis Associated With Grade 1 Lumbar Degenerative Spondylolisthesis. Clin Spine Surg 2023; 36:E416-E422. [PMID: 37348064 DOI: 10.1097/bsd.0000000000001473] [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: 12/29/2022] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN Retrospective matched cohort study. SUMMARY OF BACKGROUND DATA With a growing interest in minimally invasive spine surgery (MIS), the question of which technique is the most advantageous for patients with low-grade degenerative lumbar spondylolisthesis (DLS) still remains unclear. OBJECTIVE To compare patient-reported outcomes, perioperative morbidity, and rates of reoperation between MIS decompression with either unilateral noninstrumented facet fusion (MIS-F) or with transforaminal interbody fusion (MIS-T) for grade 1 DLS. METHODS Twenty patients who underwent MIS-T and 20 patients with MIS-F were matched based on age, sex, and preoperative ODI, VAS back, and VAS leg. All patients had DLS with at least 4 millimeters of translation on standing radiographs. Exclusion criteria included prior level surgery, multilevel instability, disk impinging on the exiting nerve root, spondylolisthesis from significant facet arthropathy, or foraminal compromise from disk collapse. ODI, VAS back, VAS leg, and patient satisfaction measured by the North American Spine Society questionnaire were tracked at 3, 6, 12, and 24 months postoperatively. Minimum clinically important differences and substantial clinical benefits were calculated. RESULTS MIS-F and MIS-T resulted in decreased ODI at 3, 6, and 12 months following the index procedure. Sixty percent of MIS-F and 83% of MIS-T patients reached minimum clinically important difference at 1 year postoperatively; however, using the threshold of 30% ODI reduction from baseline, 67% of MIS-F and 83% MIS-T ( P = 0.25) achieved this goal. Forty-three percent of MIS-F and 59% of MIS-T patients met substantial clinical benefits. Satisfaction at 1 year, measured by a score of 1 or 2 on the North American Spine Society questionnaire, was 64% for MIS-F and 83% for MIS-T. CONCLUSIONS MIS-F and MIS-T are effective treatment options for spinal stenosis associated with low-grade DLS. Both techniques result in comparable patient-reported outcomes and satisfaction up to 2 years and have similar long-term reoperation rates. More evidence is required to delineate optimal selection characteristics for MIS-F versus MIS-T.
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Affiliation(s)
| | - Nicholas Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
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Cannizzaro D, Anania CD, Safa A, Zaed I, Morenghi M, Riva M, Tomei M, Pessina F, Servadei F, Ortolina A, Fornari M. Lumbar adjacent segment degeneration after spinal fusion surgery: a systematic review and meta-analysis. J Neurosurg Sci 2023; 67:740-749. [PMID: 36345970 DOI: 10.23736/s0390-5616.22.05891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Adjacent segment degeneration is among the most recognized long-term complications of lumbar surgery for degenerative spine pathologies with a relevant impact in spine surgical and clinical practice. It is reported a incidence of clinical adjacent segment disease between 5-30% of patients undergoing spinal fusion. We aimed to evaluate the main clinical and surgical risk factors for developing adjacent segment disease. EVIDENCE ACQUISITION A systematic review and meta-analysis of the pertinent literature was performed, according to PRISMA and PICO guidelines, focusing on clinical and radiological adjacent segment disease. We exclusively included studies reporting demographic and clinical data, and surgical details published from 30 September 2015 to 30 September 2020. The effect of considered risk factors on the presence of adjacent segment disease was explored with a random-effects model. EVIDENCE SYNTHESIS A total of 15 scientific publications, corresponding to 6253 patients, met the inclusion criteria for the qualitative and quantitative analysis. 720 of the patients developed a clinical and/or radiological adjacent syndrome disease, and 473 have been surgically managed. Ten articles qualified for the comparative geographical analysis. Advanced age and obesity are relevant risk factors for developing lumbar adjacent segment degeneration. Our data also reported a higher prevalence of adjacent segment degeneration in Western populations than in Eastern populations. The interbody fusion has a protective role toward lumbar adjacent segment degeneration. CONCLUSIONS This study highlighted multifactorial issues regarding adjacent segment disease: clinical, anatomical, biomechanical, and radiological features. In view of increasing life expectancy and spinal surgery procedures, extensive multicenter studies will be needed to define the correct management of the adjacent segment disease.
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Affiliation(s)
- Delia Cannizzaro
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Carla D Anania
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale Lugano, Bellinzona, Switzerland
| | - Manuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Riva
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Massimo Tomei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Cho SS, Farber SH, DiDomenico JD, Teng CW, Park MT, Chang SW, Snyder LA, Mirzadeh Z, Uribe JS, Turner JD. Radiographic and Clinical Outcomes After Stand-Alone Anterior Lumbar Interbody Fusion for Symptomatic L5-S1 Retrolisthesis. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00979. [PMID: 38038471 DOI: 10.1227/ons.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Degenerative lumbar spondylolisthesis is associated with significant pain and disability. The literature on the treatment options and clinical outcomes for lumbar anterolisthesis is robust, but very few reports specifically evaluate lumbar retrolisthesis. This study investigated surgical outcomes for symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 anterior lumbar interbody fusion (ALIF). METHODS All patients with symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 ALIF at a single institution over a 7-year period were identified. Exhaustive nonoperative management had failed for all patients. Patients with previous lumbar fusion were excluded. Preoperative and postoperative radiographic images and patient-reported outcome measures for 20 patients (14 males and 6 females; mean [SD] age, 50.3 [13.7] years) were analyzed. RESULTS The mean (SD) follow-up was 43.0 (23.7) months (range, 12.1-102.5 months). Patients experienced postoperative improvements in L5-S1 retrolisthesis (P = .048), L5-S1 disk height and angle (P < .001), L5 foraminal height (P < .001), L5-S1 lordosis (P < .001), and lumbar lordosis (P = .01). There were no significant changes in spinopelvic parameters. At the most recent follow-up, minimal clinically important differences in Oswestry Disability Index score, 36-Item Short-Form Survey (SF-36), and numerical rating scale score for leg pain were achieved in 11 of 20 (55%), 7 of 14 (50%), and 7 of 13 (54%) patients, respectively. All patients demonstrated fusion with no graft subsidence at up to 32 months. No patient experienced intraoperative complications, was readmitted, or required a subsequent posterior decompression or fusion because of refractory symptoms. CONCLUSION In our cohort, stand-alone L5-S1 ALIF was associated with radiographic and clinical improvement in patients with symptomatic L5-S1 retrolisthesis.
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Affiliation(s)
- Steve S Cho
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Clare W Teng
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marian T Park
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Kanchiku T, Taguchi T, Sekiguchi M, Toda N, Hosono N, Matsumoto M, Tanaka N, Akeda K, Hashizume H, Kanayama M, Orita S, Takeuchi D, Kawakami M, Fukui M, Kanamori M, Wada E, Kato S, Hongo M, Ando K, Iizuka Y, Ikegami S, Kawamura N, Takami M, Yamato Y, Takahashi S, Watanabe K, Takahashi J, Konno S, Chikuda H. Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100269. [PMID: 37731461 PMCID: PMC10507637 DOI: 10.1016/j.xnsj.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Background The choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis. Methods Seventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis. Results Sixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01). Conclusions Preoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.
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Affiliation(s)
- Tsukasa Kanchiku
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Toshihiko Taguchi
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Naofumi Toda
- Department of Orthopaedic Surgery, Gunma Spine Center (Harunaso Hospital), 828-1 Kamitoyooka-cho, Takasaki City, Gunma Prefecture 370-0871, Japan
| | - Noboru Hosono
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukusima, Fukushima-ku, Osaka City, Osaka Prefecture 553-0003, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo Prefecture 160-8582, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, 1-36 Niyonosato, Hiroshimahigasi-ku, Hiroshima Prefecture 732-0057, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Masahiro Kanayama
- The Spine Center, Hakodate Central General Hospital, 33-2 Motomachi, Hakodate City, Hokkaido Prefecture 040-8585, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Chiba, Japan, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohara, Chuo-ku, Chiba City, Chiba Prefecture 260-8677, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Nasu Red-Cross Hospital, 1081-4 Nakatahara, Otahara City, Tochigi Prefecture 324-0062, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Junibancho, Wakayama City, Wakayama Prefecture 640-8158, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka Metropolitan University Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama Prefecture 930-0194, Japan
| | - Eiji Wada
- Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka City, Osaka Prefecture 543-0035, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo Prefecture 113-8655, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 44-2 Hasunuma Hiroomote, Akita City, Akita Prefecture 010-8543, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myokencho, Syowa-ku, Nagoya City, Aichi Prefecture 466-8650, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo Prefecture 150-8935, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka Prefecture 431-3192, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 754 Asahimachidoriichibancho, Chuo-ku, Niigata City, Niigata Prefecture 951-5820, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
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Indrekvam K, Bånerud IF, Hermansen E, Austevoll IM, Rekeland F, Guddal MH, Solberg TK, Brox JI, Hellum C, Storheim K. The Norwegian degenerative spondylolisthesis and spinal stenosis (NORDSTEN) study: study overview, organization structure and study population. 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 2023; 32:4162-4173. [PMID: 37395780 DOI: 10.1007/s00586-023-07827-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To provide an overview of the The Norwegian Degenerative spondylolisthesis and spinal stenosis (NORDSTEN)-study and the organizational structure, and to evaluate the study population. METHODS The NORDSTEN is a multicentre study with 10 year follow-up, conducted at 18 public hospitals. NORDSTEN includes three studies: (1) The randomized spinal stenosis trial comparing the impact of three different decompression techniques; (2) the randomized degenerative spondylolisthesis trial investigating whether decompression surgery alone is as good as decompression with instrumented fusion; (3) the observational cohort tracking the natural course of LSS in patients without planned surgical treatment. A range of clinical and radiological data are collected at defined time points. To administer, guide, monitor and assist the surgical units and the researchers involved, the NORDSTEN national project organization was established. Corresponding clinical data from the Norwegian Registry for Spine Surgery (NORspine) were used to assess if the randomized NORDSTEN-population at baseline was representative for LSS patients treated in routine surgical practice. RESULTS A total of 988 LSS patients with or without spondylolistheses were included from 2014 to 2018. The clinical trials did not find any difference in the efficacy of the surgical methods evaluated. The NORDSTEN patients were similar to those being consecutively operated at the same hospitals and reported to the NORspine during the same time period. CONCLUSION The NORDSTEN study provides opportunity to investigate clinical course of LSS with or without surgical interventions. The NORDSTEN-study population were similar to LSS patients treated in routine surgical practice, supporting the external validity of previously published results. TRIAL REGISTRATION ClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.
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Affiliation(s)
- Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ingrid Fjeldheim Bånerud
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maren Hjelle Guddal
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tore K Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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