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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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Heo KY, Bonsu JM, Khawaja S, Karzon A, Rajan PV, Barber LA, Yoon ST. Database analysis comparing incidence and complication rates between inpatient and outpatient laminotomies for lumbar disc herniation. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100328. [PMID: 38966040 PMCID: PMC11222817 DOI: 10.1016/j.xnsj.2024.100328] [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: 02/23/2024] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 07/06/2024]
Abstract
Background Lumbar disc herniation (LDH) is a common condition that can be characterized with disabling pain. While most patients recover without surgery, some still require operative intervention. The epidemiology and trends of laminotomy for LDH have not been recently studied, and current practice patterns might be different from historical norms. This study aimed to investigate the trends of inpatient and outpatient laminotomies for LDH and compare complication rates between these two sites of service. Methods A large, national database was utilized to identify patients > 8 years old who underwent a laminotomy for LDH between 2009 and 2019. Two cohorts were created based on site of surgery: inpatient versus outpatient. The outpatient cohort was defined as patients who had a length of stay less than 1 day without any associated hospitalization. Epidemiologic analyses for these cohorts were performed by demographics. Patients in both groups were then 1:1 propensity-score matched based on age, sex, insurance type, geographic region, and comorbidities. Ninety-day postoperative complications were compared between cohorts utilizing multivariate logistic regressions. Results The average incidence of laminotomy for LDH was 13.0 per 10,000 persons-years. Although the national trend in incidence had not changed from 2009 to 2019, the proportion of outpatient laminotomies significantly increased in this time period (p=.02). Outpatient laminotomies were more common among younger and healthier patients. Patients with inpatient laminotomies had significantly higher rates of surgical site infections (odds ratio [OR] 1.61, p<.001), venous thromboembolism (VTE) (OR 1.96, p<.001), hematoma (OR 1.71, p<.001), urinary tract infections (OR 1.41, p<.001), and acute kidney injuries (OR 1.75, p=.001), even when controlling for selected confounders. Conclusions Our study demonstrated an increasing trend in the performance of laminotomy for LDH toward the outpatient setting. Even when controlling for certain confounders, patients requiring inpatient procedures had higher rates of postoperative complications. This study highlights the importance of carefully evaluating the advantages and disadvantages of performing these procedures in an outpatient versus inpatient setting.
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Affiliation(s)
- Kevin Y. Heo
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Janice M. Bonsu
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Sameer Khawaja
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Anthony Karzon
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Prashant V. Rajan
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Lauren A. Barber
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
| | - Sangwook Tim Yoon
- Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Ln, Atlanta, GA 30329, United States
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Xu Z, Hu B, Zheng G, Yu W, Yang C, Wang H, Chen K, He S, Liang L, Xu C, Wu X, Zang F, Yuan WE, Chen H. Metformin-grafted polycaprolactone nanoscaffold targeting sensory nerve controlled fibroblasts reprograming to alleviate epidural fibrosis. J Control Release 2024; 367:791-805. [PMID: 38341179 DOI: 10.1016/j.jconrel.2024.02.001] [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: 10/25/2023] [Revised: 01/17/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Epidural fibrosis (EF), associated with various biological factors, is still a major troublesome clinical problem after laminectomy. In the present study, we initially demonstrate that sensory nerves can attenuate fibrogenic progression in EF animal models via the secretion of calcitonin gene-related peptide (CGRP), suggesting a new potential therapeutic target. Further studies showed that CGRP could inhibit the reprograming activation of fibroblasts through PI3K/AKT signal pathway. We subsequently identified metformin (MET), the most widely prescribed medication for obesity-associated type 2 diabetes, as a potent stimulator of sensory neurons to release more CGRP via activating CREB signal way. We copolymerized MET with innovative polycaprolactone (PCL) nanofibers to develop a metformin-grafted PCL nanoscaffold (METG-PCLN), which could ensure stable long-term drug release and serve as favorable physical barriers. In vivo results demonstrated that local implantation of METG-PCLN could penetrate into dorsal root ganglion cells (DRGs) to promote the CGRP synthesis, thus continuously inhibit the fibroblast activation and EF progress for 8 weeks after laminectomy, significantly better than conventional drug loading method. In conclusion, this study reveals the unprecedented potential of sensory neurons to counteract EF through CGRP signaling and introduces a novel strategy employing METG-PCLN to obstruct EF by fine-tuning sensory nerve-regulated fibrogenesis.
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Affiliation(s)
- Zeng Xu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Bo Hu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Genjiang Zheng
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Wei Yu
- Shanghai Frontiers Science Center of Drug Target Identification and Delivery, School of Pharmaceutical Sciences, Shanghai Jiao Tong University, Shanghai 200240, China; Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, China; National Key Laboratory of Innovative Immunotherapy, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chen Yang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Hui Wang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Keyi Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Shatong He
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Lei Liang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Chen Xu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xiaodong Wu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Fazhi Zang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
| | - Wei-En Yuan
- Shanghai Frontiers Science Center of Drug Target Identification and Delivery, School of Pharmaceutical Sciences, Shanghai Jiao Tong University, Shanghai 200240, China; Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, China; National Key Laboratory of Innovative Immunotherapy, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
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Haggerty T, Milligan S, Davisson L, Cavrak M, Imlay R, Sedney C. Significant symptom resolution of spinal lipomatosis with weight loss. Clin Case Rep 2023; 11:e7126. [PMID: 37692150 PMCID: PMC10491747 DOI: 10.1002/ccr3.7126] [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: 09/16/2022] [Revised: 01/20/2023] [Accepted: 03/02/2023] [Indexed: 09/12/2023] Open
Abstract
71-year-old male with epidural spinal lipomatosis and spondylolisthesis. Conservative treatment failed, and a spinal fusion and laminectomy were performed. Postoperatively, the patient reported a reduction in pain; however, the pain recurred soon after surgery. After losing 53 pounds with medical management, the patient reported a complete absence of pain. Epidural spinal lipomatosis is a rare condition characterized by the deposition and hypertrophy of adipose tissue in the spinal canal, sometimes resulting in stenosis or compression of the dural sac and nerve roots (Glob Spine J. 2018;9:658). Although several factors are considered to precipitate the disease, steroid use (J Am Acad Dermatol. 2017;76:1) and obesity (Neurosurg Focus. 2004;16:1) are considered among the most prevalent, with obesity controversially being listed under "idiopathic" causes occasionally (Glob Spine J. 2018;9:658). Weight reduction and decreased steroid use are first-line treatments for this disorder, and usually surgery is considered only when conservative treatment is ineffective (Glob Spine J. 2018;9:658). To describe a case of treating spinal lipomatosis within an evidence-based multidisciplinary medical weight management clinic.
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Affiliation(s)
- Treah Haggerty
- Department of Family MedicineWVU Medicine Medical and Surgical Weight Loss Center's Medical Weight Management Program, West Virginia University2nd Floor HSSMorgantownWest Virginia26506USA
| | | | - Laura Davisson
- Department of Internal Medicine, West Virginia University School of MedicineWVU Medicine Medical and Surgical Weight Loss Center's Medical Weight Management ProgramMorgantownWest Virginia26506USA
| | - Megan Cavrak
- School of MedicineWest Virginia UniversityMorgantownWest Virginia26506USA
| | - Riley Imlay
- School of MedicineWest Virginia UniversityMorgantownWest Virginia26506USA
| | - Cara Sedney
- West Virginia UniversityDepartment of Neurosurgery4 Floor HSCSMorgantownWest Virginia26506USA
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Sastry RA, Chen JS, Shao B, Weil RJ, Chang KE, Maynard K, Syed SH, Zadnik Sullivan PL, Camara JQ, Niu T, Sampath P, Telfeian AE, Oyelese AA, Fridley JS, Gokaslan ZL. Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019. JAMA Netw Open 2023; 6:e2326357. [PMID: 37523184 PMCID: PMC10391306 DOI: 10.1001/jamanetworkopen.2023.26357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Use of lumbar fusion has increased substantially over the last 2 decades. For patients with lumbar stenosis and degenerative spondylolisthesis, 2 landmark prospective randomized clinical trials (RCTs) published in the New England Journal of Medicine in 2016 did not find clear evidence in favor of decompression with fusion over decompression alone in this population. Objective To assess the national use of decompression with fusion vs decompression alone for the surgical treatment of lumbar stenosis and degenerative spondylolisthesis from 2016 to 2019. Design, Setting, and Participants This retrospective cohort study included 121 745 hospitalized adult patients (aged ≥18 years) undergoing 1-level decompression alone or decompression with fusion for the management of lumbar stenosis and degenerative spondylolisthesis from January 1, 2016, to December 31, 2019. All data were obtained from the National Inpatient Sample (NIS). Analyses were conducted, reviewed, or updated on June 9, 2023. Main Outcome and Measure The primary outcome of this study was the use of decompression with fusion vs decompression alone. For the secondary outcome, multivariable logistic regression analysis was used to evaluate factors associated with the decision to perform decompression with fusion vs decompression alone. Results Among 121 745 eligible hospitalized patients (mean age, 65.2 years [95% CI, 65.0-65.4 years]; 96 645 of 117 640 [82.2%] non-Hispanic White) with lumbar stenosis and degenerative spondylolisthesis, 21 230 (17.4%) underwent decompression alone, and 100 515 (82.6%) underwent decompression with fusion. The proportion of patients undergoing decompression alone decreased from 2016 (7625 of 23 405 [32.6%]) to 2019 (3560 of 37 215 [9.6%]), whereas the proportion of patients undergoing decompression with fusion increased over the same period (from 15 780 of 23 405 [67.4%] in 2016 to 33 655 of 37 215 [90.4%] in 2019). In univariable analysis, patients undergoing decompression alone differed significantly from those undergoing decompression with fusion with regard to age (mean, 68.6 years [95% CI, 68.2-68.9 years] vs 64.5 years [95% CI, 64.3-64.7 years]; P < .001), insurance status (eg, Medicare: 13 725 of 21 205 [64.7%] vs 53 320 of 100 420 [53.1%]; P < .001), All Patient Refined Diagnosis Related Group risk of death (eg, minor risk: 16 900 [79.6%] vs 83 730 [83.3%]; P < .001), and hospital region of the country (eg, South: 7030 [33.1%] vs 38 905 [38.7%]; Midwest: 4470 [21.1%] vs 23 360 [23.2%]; P < .001 for both comparisons). In multivariable logistic regression analysis, older age (adjusted odds ratio [AOR], 0.96 per year; 95% CI, 0.95-0.96 per year), year after 2016 (AOR, 1.76 per year; 95% CI, 1.69-1.85 per year), self-pay insurance status (AOR, 0.59; 95% CI, 0.36-0.95), medium hospital size (AOR, 0.77; 95% CI, 0.67-0.89), large hospital size (AOR, 0.76; 95% CI, 0.67-0.86), and highest median income quartile by patient residence zip code (AOR, 0.79; 95% CI, 0.70-0.89) were associated with lower odds of undergoing decompression with fusion. Conversely, hospital region in the Midwest (AOR, 1.34; 95% CI, 1.14-1.57) or South (AOR, 1.32; 95% CI, 1.14-1.54) was associated with higher odds of undergoing decompression with fusion. Decompression with fusion vs decompression alone was associated with longer length of stay (mean, 2.96 days [95% CI, 2.92-3.01 days] vs 2.55 days [95% CI, 2.49-2.62 days]; P < .001), higher total admission costs (mean, $30 288 [95% CI, $29 386-$31 189] vs $16 190 [95% CI, $15 189-$17 191]; P < .001), and higher total admission charges (mean, $121 892 [95% CI, $119 566-$124 219] vs $82 197 [95% CI, $79 745-$84 648]; P < .001). Conclusions and Relevance In this cohort study, despite 2 prospective RCTs that demonstrated the noninferiority of decompression alone compared with decompression with fusion, use of decompression with fusion relative to decompression alone increased from 2016 to 2019. A variety of patient- and hospital-level factors were associated with surgical procedure choice. These results suggest the findings of 2 major RCTs have not yet produced changes in surgical practice patterns and deserve renewed focus.
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Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jia-Shu Chen
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Robert J Weil
- Department of Neurosurgery, Brain and Spine, Southcoast Health, Dartmouth, Massachusetts
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ken Maynard
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sohail H Syed
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Joaquin Q Camara
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
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Reimbursement of Lumbar Decompression at an Orthopedic Specialty Hospital Versus Tertiary Referral Center. Spine (Phila Pa 1976) 2021; 46:1581-1587. [PMID: 34714795 DOI: 10.1097/brs.0000000000004067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to investigate the differences in Medicare reimbursement for one- to three-level lumbar decompression procedures performed at a tertiary referral center versus an orthopedic specialty hospital (OSH). SUMMARY OF BACKGROUND DATA Lumbar decompression surgery is one of the most commonly performed spinal procedures. Lumbar decompression also comprises the largest proportion of spinal surgery that has transitioned to the outpatient setting. METHODS Patients who underwent a primary one- to three- level lumbar decompression were retrospectively identified. Reimbursement data for a tertiary referral center and an OSH were compiled through Centers for Medicare and Medicaid Services. Demographic data, surgical characteristics, and time cost data were collected through chart review. Multivariate regression models were used to determine independent factors associated with total episode of care cost, operating room (OR) time, procedure time, and length of stay (LOS), and to determine independent predictors of having the decompression performed at the OSH. RESULTS Total episode of care, facility, and non-facility payments were significantly greater at the tertiary referral center than the OSH, as were OR time for one- to three-level procedures, procedure time of all pooled levels, and LOS for one- and two-level procedures. Three-level procedure was independently associated with increased OR time, procedure time, and LOS. Age and two-level procedure were also associated with increased LOS. Procedure at the OSH was associated with decreased OR time and LOS. Charlson Comorbidity Index was a negative predictor of decompression being performed in the OSH setting. CONCLUSION Significant financial savings to health systems can be expected when performing lumbar decompression surgery at a specialty hospital as opposed to a tertiary referral center. Patients who are appropriate candidates for surgery in an OSH can in turn expect faster perioperative times and shorter LOS.Level of Evidence: 3.
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Juneja P, Frenkel MB, Carmichael SP, Sarwal A. Gray-Scale Sonography of the Spinal Cord in Postlaminectomy Patient. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320972099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laminectomy, a common neurosurgical procedure that decompresses the spinal cord, is the definitive surgical treatment for spinal epidural abscesses. Although complications after laminectomy occur infrequently, they can cause significant morbidity and health care resource usage. These complications include soft tissue collections like a persistent and/or new abscess or a hematoma. The preferred method of diagnosis for spinal soft tissue collections is magnetic resonance imaging. However, traditional neuroimaging poses significant challenges in patients with spinal hardware due to metallic artifact precluding appropriate visualization of anatomy and pathology. This was a case of a patient with extensive spinal hardware where visualization of the spinal cord by postoperative sonography was made feasible by a lack of bone after a laminectomy. Point-of-care ultrasound, a convenient bedside tool with the ability to detect soft tissue collections easily, was used to monitor for postoperative recurrence of a spinal epidural abscess in this patient. Patients with an intact spine do not have adequate acoustic windows due to posterior vertebral anatomy. In postlaminectomy patients without posterior vertebral structures, sonography may offer a diagnostic modality for postoperative monitoring. Ultrasonographers can employ spinal cord sonography, particularly when the indication for decompressive laminectomy was a localized fluid collection or abscess.
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Affiliation(s)
| | - Mark B. Frenkel
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Sam P. Carmichael
- Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Change of the Shape of the Dural Sac in the Laminectomy Model at Different Stages of the Reparation in the Experiment. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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