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Levy HA, Karamian BA, Pezzulo J, Canseco JA, Sherman MB, Kurd MF, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Do Patient Outcomes Predict Loss to Long-Term Follow-Up After Spine Surgery? World Neurosurg 2023; 170:e301-e312. [PMID: 36371041 DOI: 10.1016/j.wneu.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if spine surgery patients with greater improvement in patient-reported outcomes measures (PROMs) at early postoperative follow-up are more likely to be lost to follow-up at the 1-year and 2-year postoperative visits. METHODS All patients older than 18 years who underwent primary or revision decompression or fusion surgery for degenerative spinal conditions at an academic institution were retrospectively identified. Univariate analysis compared patient demographics, surgical factors, and changes in short-term and long-term postoperative PROMs (Neck Disability Index, Oswestry Disability Index, visual analog scale [VAS] neck, VAS arm, VAS back, VAS leg, and Short-Form 12 Physical and Mental Component Scores) across groups with and without 1 year and 2 years follow-up. Logistic regression isolated predictors of loss to follow-up. RESULTS A total of 1412 patients were included. Younger patient age, primary surgery, and single surgical approach independently predicted loss at 1 year follow-up. Female sex predicted loss at 2 years follow-up, whereas multilevel fusion surgery predicted attendance at 2 years clinical follow-up. In patients lost at 1 year follow-up compared with those who attended, preoperative to 3-month Mental Component Score and VAS neck pain improvement was significantly greater. When comparing patients based on 2 years follow-up status, VAS back pain improvement at 1 year postoperatively was significantly greater in patients lost to 2 years follow-up. All other changes in PROMs did not differ significantly by 1 or 2 years follow-up attendance. CONCLUSIONS Overall patient outcomes were not found to affect loss to long-term follow-up after spine surgery. The general lack of association between postoperative follow-up status and clinical outcome may limit bias introduced in retrospective PROM studies.
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Affiliation(s)
- Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
| | - Joshua Pezzulo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Matthew B Sherman
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Shuman WH, Neifert SN, Gal JS, Snyder DJ, Deutsch BC, Zimering JH, Rothrock RJ, Caridi JM. The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion. Global Spine J 2022; 12:780-786. [PMID: 33034217 PMCID: PMC9344522 DOI: 10.1177/2192568220964053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Anterior cervical discectomy and fusion (ACDF) is commonly used to treat an array of cervical spine pathology and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is a common comorbidity for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes. Because DM is a highly prevalent comorbidity, it is crucial to determine if it is an associated risk factor for outcomes after ACDF procedures. METHODS Patients at a single institution from 2008 to 2016 undergoing ACDF were compared on the basis of having a prior diagnosis of DM versus no DM. The 2 cohorts were compared utilizing univariate tests and multivariate logistic and linear regressions. RESULTS Data for 2470 patients was analyzed. Diabetic patients had significantly higher Elixhauser scores (P < .0001). Univariate testing showed diabetic patients were more likely to suffer from sepsis (0.82% vs 0.10%, P = .03) and bleeding complications (3.0% vs 1.5%, P = .04). In multivariate analyses, diabetic patients had higher rates of non-home discharge (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.07-1.75, P = .013) and prolonged length of stay (OR = 1.95, 95% CI = 1.25-3.05, P = .003), but similar complication (OR = 1.46, 95% CI = 0.85-2.52, P = .17), reoperation (OR = 0.77, 95% CI = 0.33-1.81, P = .55), and 90-day readmission (OR = 1.53, 95% CI = 0.97-2.43) rates compared to nondiabetic patients. Direct cost was also shown to be similar between the cohorts after adjusting for patient, surgical, and hospital-related factors (estimate = -$30.25, 95% CI = -$515.69 to $455.18, P = .90). CONCLUSIONS Diabetic patients undergoing ACDF had similar complication, reoperation, and readmission rates, as well as similar cost of care compared to nondiabetic patients.
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Affiliation(s)
- William H. Shuman
- Icahn School of Medicine at Mount
Sinai, New York, NY, USA,Will Shuman, Department of Neurosurgery,
Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY
10029, USA.
| | | | | | | | | | | | | | - John M. Caridi
- Icahn School of Medicine at Mount
Sinai, New York, NY, USA
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Patel MR, Jacob KC, Parsons AW, Chavez FA, Prabhu MC, Pawlowski H, Vanjani NN, Singh K. Influence of Predominant Neck vs Arm Pain on ACDF Outcomes: A Follow-Up Study. World Neurosurg 2022; 160:e288-e295. [PMID: 35017074 DOI: 10.1016/j.wneu.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess differences in postoperative PROMs and MCID attainment following single-level ACDF based on predominant preoperative pain symptom. METHODS Primary, single-level ACDFs were identified. PROMs included VAS arm and neck/SF-12 PCS/PROMIS-PF/NDI, collected preoperatively and at 6-week/12-week/6-month/1-year/2-year postoperative timepoints. Patients were grouped: pAP (preoperative VAS arm > preoperative VAS neck) vs pNP (preoperative VAS neck > preoperative VAS arm). Chi-square and Student's t-test compared demographic and perioperative characteristics. Student's t-test evaluated change from preoperative to postoperative PROM values, and compared PROMs between groups. MCID achievement was determined using established threshold values. MCID attainment rates were compared using chi-squared. RESULTS 110 patients were assessed-52 pNP/58 pAP. Demographics did not differ between cohorts. Total 1-year arthrodesis rate was 95.7% and did not differ by grouping. pNP patients improved significantly from preoperative to postoperative at 12-weeks-1-year for PROMIS-PF, 6-months/1-year for SF-12 PCS, 6-weeks-1-year for VAS neck, 6-weeks-6-months for VAS arm, and 6-weeks through 2-years for NDI(p≤0.035, all). pAP patients improved significantly from preoperative to all postoperative timepoints for PROMIS-PF, 6-months-2-years for SF-12 PCS, 6-weeks-1-year for VAS neck, 6-weeks-1-year for VAS arm, and 6-weeks-6-months for NDI(p≤0.040, all). Mean PROMIS-PF was higher for pAP at 6-weeks, preoperative VAS neck lower for pAP, and preoperative VAS arm higher for pAP(p≤0.013, all). MCID attainment was significantly higher among pAP only for PROMIS-PF from 6-weeks-6-months, SF-12 PCS 6-weeks, and VAS arm 12-weeks. CONCLUSION Predominant pain symptom demonstrated little effect on perioperative characteristics and postoperative PROMs. ACDF candidates will likely experience similar clinically meaningful postoperative improvements in physical function/disability/pain.
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Affiliation(s)
- Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Alexander W Parsons
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Frank A Chavez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612.
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Wichmann TO, Rasmussen MM, Einarsson HB. Predictors of patient satisfaction following anterior cervical discectomy and fusion for cervical radiculopathy. Clin Neurol Neurosurg 2021; 205:106648. [PMID: 33901749 DOI: 10.1016/j.clineuro.2021.106648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 04/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate whether preoperative patient-reported outcome measures (PROMs) and immediate postoperative arm pain improvement can predict patient satisfaction following anterior cervical spine surgery. METHODS A retrospective analysis of prospectively collected data from 193 patients with cervical radiculopathy undergoing surgery at Aarhus University Hospital was performed. Standardized questionnaires were used to assess demographics, clinical outcomes and complications preoperatively, postoperatively and at 1-year follow-up. PROMs covered Visual Analogue Scale for arm pain (VAS-AP) and neck pain (VAS-NP), Neck Disability Index (NDI), EQ-5D 3-level version (EQ-5D-3L), and satisfaction. Immediate upper extremity pain status was assembled from medical records. RESULTS PROMs significantly improved (p < 0.001) and most patients (66%) were satisfied with the surgical result at follow-up. Complications and complaints occurred in 3.6% intraoperatively, 1.5% postoperatively in-hospital, and 43% postoperatively post-discharge. Patients with a symptom duration exceeding 24 months had significantly decreased odds of being satisfied compared to patients with a symptom duration less than 3 months (OR: 0.32, 95% CI: 0.10-0.98, p = 0.046). Neither baseline PROMs nor immediate pain improvement significantly predicted patient satisfaction. Despite being non-significant, patients experiencing immediate pain improvement had increased odds of being satisfied compared to patients not experiencing immediate improvement (OR: 1.62, 95% CI: 0.65-4.05). CONCLUSIONS Prolonged symptom duration and immediate pain improvement may have an impact on patient satisfaction.
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Affiliation(s)
- Thea Overgaard Wichmann
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - Mikkel Mylius Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - Halldór Bjarki Einarsson
- Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
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Patel AA, Walker CT, Prendergast V, Radosevich JJ, Grimm D, Godzik J, Whiting AC, Kakarla UK, Mirzadeh Z, Uribe JS, Turner JD. Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events. Neurosurgery 2021; 87:592-601. [PMID: 32357244 DOI: 10.1093/neuros/nyaa111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion. OBJECTIVE To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices. METHODS A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients were divided into cohorts on the basis of postoperative treatment with PCA or NCA. Postoperative pain scores, length of stay, and total opioid consumption data were collected. Patients were stratified according to preoperative opioid consumption as opioid naive (0 morphine milligram equivalents [MME] daily), low consumption (1-60 MME), high consumption (61-90 MME), or very high consumption (>90 MME). RESULTS A total of 240 patients were identified, including 62 in the PCA group and 178 in the NCA group. PCA patients had higher mean preoperative opioid consumption than NCA patients (49.2 vs 24.3 MME, P = .009). PCA patients had higher mean opioid consumption in the first 72 h in all 4 of the preoperative opioid consumption subcategories. Pain control and adverse event rates were similar between PCA and NCA in the low to high preoperative opioid consumption groups. CONCLUSION Postoperative PCA is associated with significantly more opioid consumption in the first 72 h after surgery and equal or worse postoperative pain scores compared with NCA after lumbar spinal fusion surgery.
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Affiliation(s)
- Arpan A Patel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Virginia Prendergast
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - John J Radosevich
- Department of Pharmacy, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Doneen Grimm
- Department of Pharmacy, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Zaman Mirzadeh
- 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
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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On the importance of the innervation of the human cervical longitudinal ligaments at vertebral level. Surg Radiol Anat 2019; 42:127-136. [PMID: 31493007 DOI: 10.1007/s00276-019-02316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE In our aging society, the prevalence of degenerative spinal diseases rose drastically within the last years. However, up till now, the origin of cervical pain is incompletely understood. While animal and small cadaver studies indicate that a complex system of sensory and nociceptive nerve fibers in the anterior (ALL) and posterior longitudinal ligament (PLL) at the level of the intervertebral disc might be involved, there is a lack of data exploring whether such a network exists and is equally distributed within the cervical vertebrae (VB). We, therefore, aimed to investigate the spatial distribution of the mentioned nerve networks in human tissue. METHODS We performed macroscopic (Sihler staining, Spalteholz technique, and Plastination) and microscopic (immunohistochemistry for PGP 9.5 and CGRP) studies to characterize spatial differences in sensory and nociceptive innervation patterns. Therefore, 23 human body donors were dissected from level C3-C6. RESULTS We could show that there is a focal increase in sensory and nociceptive nerve fibers at the level of C4 and C5 for both ALL and PLL, while we observed less nerve fiber density at the level of C3 and C6. An anatomical vicinity between nerve and vessels was observed. CONCLUSION To our knowledge, these findings for the first time report spatial differences in sensory and nociceptive nerve fibers in the human cervical spine at VB level. The interconnection between nerves and vessels supports the importance of the perivascular plexus. These findings might be of special interest for clinical practice as many patients suffer from pain after cervical spine surgery.
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