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Boddeti U, Polavarapu H, Patel S, Choudhary A, Langbein J, Nusraty S, Vatsa S, Brahmbhatt P, Mitha R. Current Status of Awake Spine Surgery: A Bibliometric Analysis. World Neurosurg 2024:S1878-8750(24)00749-6. [PMID: 38719075 DOI: 10.1016/j.wneu.2024.04.179] [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: 02/01/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Spine surgery accounts for a large proportion of neurosurgical procedures, with approximately 313 million spine surgeries conducted annually worldwide. Considering delayed recovery and postoperative complications that are commonly reported, there has been a recent shift toward minimally invasive spine procedures conducted under local anesthesia. Despite proven success, there exists a limited body of literature on the use of awake surgery in spinal procedures. METHODS A bibliometric analysis was conducted to map the current landscape of work in this field. 190 articles were identified from the Web of Science (Clarivate, NY) database. A comprehensive bibliometric analysis was performed on a narrowed list of the most relevant articles using Bibliometrix, an R-based programming tool. RESULTS There has been a rise in academic papers published on the topic of awake spine surgery since 2016, with an increase in publication count by approximately 18% annually and each article cited approximately ten times on average to date. The year 2022 saw an uptick in publications, with 9 throughout the entire year. The most impactful article, with a total of 95 citations, was published by Sairyo et al.1 Thematic analysis revealed that the terms "lumbar spine" and "stenosis" are well-developed topics in the literature, whereas the topics of "complications," "fusion," and "cost-analysis" are less well-developed topics. CONCLUSIONS This study provides a comprehensive overview of the most-cited articles in the field of awake spine surgery. Specifically, it identifies areas that are well represented in the literature and those which are underrepresented and should be areas of continued future research.
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Affiliation(s)
- Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hanish Polavarapu
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shrey Patel
- Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Aditi Choudhary
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jenna Langbein
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sabrina Nusraty
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sonika Vatsa
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Priya Brahmbhatt
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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2
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Ma K, Uejima JL, Bebawy JF. Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence. J Neurosurg Anesthesiol 2024; 36:109-118. [PMID: 36941119 DOI: 10.1097/ana.0000000000000911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
Neurosurgical procedures are often associated with significant postoperative pain that is both underrecognized and undertreated. Given the potentially undesirable side effects associated with general anesthesia and with various pharmacological analgesic regimens, regional anesthetic techniques have gained in popularity as alternatives for providing both anesthesia and analgesia for the neurosurgical patient. The aim of this narrative review is to present an overview of the regional techniques that have been incorporated and continue to be incorporated into modern neuroanesthesia practice, presenting in a comprehensive way the evidence, where available, in support of such practice for the neurosurgical patient.
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Affiliation(s)
- Kan Ma
- Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - John F Bebawy
- Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Rajjoub R, Ghaith AK, El-Hajj VG, Rios-Zermano J, De Biase G, Atallah E, Tfaily A, Saad H, Akinduro OO, Elmi-Terander A, Abode-Iyamah K. Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive 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; 33:985-1000. [PMID: 38110776 DOI: 10.1007/s00586-023-08071-y] [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: 08/19/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic. METHODS A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models. RESULTS In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): - 0.40 days; 95% CI - 0.64 to - 0.17) and operative time (MD: - 19.17 min; 95% CI - 29.68 to - 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI 0.37-0.99]). CONCLUSIONS Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Victor Gabriel El-Hajj
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ali Tfaily
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Kingsley Abode-Iyamah
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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4
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Bai X, Yin X, Hao N, Zhao Y, Ling Q, Yang B, Huang X, Long W, Li X, Zhao G, Tong Z. Effect of propofol and sevoflurane on postoperative fatigue after laparoscopic hysterectomy. J Psychosom Res 2024; 178:111605. [PMID: 38368651 DOI: 10.1016/j.jpsychores.2024.111605] [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: 07/03/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Postoperative fatigue syndrome (POFS) is an important factor in postoperative recovery. However, the effect of anesthetic drugs on postoperative fatigue in female patients has been rarely studied. This study compared the effects of maintaining general anesthesia with propofol or sevoflurane on the incidence of POFS in patients undergoing laparoscopic hysterectomy. METHODS This prospective, single-blind, randomized controlled trial enrolled patients scheduled for laparoscopic hysterectomy. Eligible patients were randomized into the propofol and sevoflurane groups. The primary outcome was the incidence of POFS within 30 Days, defined by a simplified identity consequence fatigue scale (ICFS-10) scores≥24 or Visual Analogue Scale (VAS) scores of fatigues>6. Secondary outcomes were perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days. RESULTS 32 participants were assigned to the propofol group (P) and 33 to the sevoflurane group (S). Incidence of POFS on postoperative D1 was P (8/32) vs. S (10/33) (p = 0.66, 95% confidence interval [CI]: 16.4-27.00); D3 P (2/32) vs. S (5/33) (p = 0.45,95% CI:5.96-23.76). POFS were not found on postoperative D5 and D30. There were no differences in perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days between the two groups. CONCLUSIONS POFS after scheduled laparoscopic hysterectomy was unaffected by anesthesia with propofol vs. sevoflurane. The incidence of POFS was highest on the first postoperative day, at 27.7%, and declined progressively over the postoperative 30 days. Trial registration Chinese Clinical Trial Registry (No. ChiCTR 2,000,033,861), registered on 14/06/2020).
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Affiliation(s)
- Xue Bai
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Xiuju Yin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ning Hao
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Yue Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Qiong Ling
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Bo Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Xiaoling Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Wenfei Long
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Xiangyu Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Gaofeng Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China
| | - Zhilan Tong
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, PR China.
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Ghaith AK, Akinduro OO, El-Hajj VG, De Biase G, Ghanem M, Rajjoub R, Faisal UH, Saad H, Abdulrahim M, Bon Nieves A, Chen SG, Pirris SM, Bydon M, Abode-Iyamah K. General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years. Neurosurgery 2024; 94:413-422. [PMID: 37856210 DOI: 10.1227/neu.0000000000002670] [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: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nongeneral anesthesia (non-GA) spine surgery is growing in popularity and has facilitated earlier postoperative recovery, reduced cost, and fewer complications compared with spine surgery under general anesthesia (GA). Changes in reimbursement policies have been demonstrated to correlate with clinical practice; however, they have yet to be studied for GA vs non-GA spine procedures. We aimed to investigate trends in physician reimbursement for GA vs non-GA spine surgery in the United States. METHODS We queried the ACS-NSQIP for GA and non-GA (regional, epidural, spinal, and anesthesia care/intravenous sedation) spine surgeries during 2011-2020. Work relative value units per operative hour (wRVUs/h) were retrieved for decompression or stabilization of the cervical, thoracic, and lumbar spine. Propensity score matching (1:1) was performed using all baseline variables. RESULTS We included 474 706 patients who underwent spine decompression or stabilization procedures. GA was used in 472 248 operations, whereas 2458 operations were non-GA. The proportion of non-GA spine operations significantly increased during the study period. Operative times ( P < .001) and length of stays ( P < .001) were shorter in non-GA when compared with GA procedures. Non-GA lumbar procedures had significantly higher wRVUs/h when compared with the same procedures performed under GA (decompression; P < .001 and stabilization; P = .039). However, the same could not be said about cervicothoracic procedures. Lumbar decompression surgeries using non-GA witnessed significant yearly increase in wRVUs/h ( P < .01) contrary to GA ( P = .72). Physician reimbursement remained stable for procedures of the cervical or thoracic spine regardless of the anesthesia. CONCLUSION Non-GA lumbar decompressions and stabilizations are associated with higher and increasing reimbursement trends (wRVUs/h) compared with those under GA. Reimbursement for cervical and thoracic surgeries was equal regardless of the type of anesthesia and being relatively stable during the study period. The adoption of a non-GA technique relative to the GA increased significantly during the study period.
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Affiliation(s)
- Abdul Karim Ghaith
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | | | - Victor Gabriel El-Hajj
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
- Department of Neurosurgery, Karolinska University Hospital, Stockholm , Sweden
| | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut , Lebanon
| | - Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | - Umme Habiba Faisal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Hassan Saad
- Department of Neurological Surgery, Emory University, Atlanta , Georgia , USA
| | - Mostafa Abdulrahim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Antonio Bon Nieves
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
| | - Selby G Chen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Stephen M Pirris
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester , Minnesota , USA
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De Biase G, Otamendi-Lopez A, Chen S, Bojaxhi E, Gruenbaum SE, Quinones-Hinojosa A, Abode-Iyamah K. Impact of postoperative fatigue following minimally-invasive lumbar spine surgery. J Clin Neurosci 2023; 112:64-67. [PMID: 37104885 DOI: 10.1016/j.jocn.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/02/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Postoperative fatigue is a distressing symptom and can have a major impact on the patient's quality of life after surgery. We investigate the extent of postoperative fatigue following minimally invasive spine surgery under general anesthesia (GA), and its impact on patients' quality of life (QOL) and activities of daily living (ADLs). METHODS We surveyed patients that underwent minimally-invasive lumbar spine surgery under GA within the previous year. A five-point Likert scale ("very much", "quite a bit", "somewhat", "a little bit", "not at all") was used to assess the extent of fatigue during the first postoperative month, its impact on QOL, and ADLs. RESULTS The survey was completed by 100 patients, 61% were male, mean age 64.6 ± 12.5 years, 31% underwent MIS-TLIF, 69% lumbar laminectomy. During the first postoperative month 45% of patients referred significant fatigue ("very much" or "quite a bit"); for 31% of patients fatigue significantly impacted their QOL; significantly limited their ADLs in 43% of patients. MIS-TLIF was associated with higher rate of postoperative fatigue compared to laminectomy (61.3% versus 37.7%, p = 0.02). Patients 65 years old or older had higher rates of fatigue compared to younger patients (55.6% versus 32.6%, p = 0.02). We did not observe a significant difference in postoperative fatigue between male and female patients. CONCLUSIONS Our study revealed a substantial incidence of postoperative fatigue in patients that underwent minimally-invasive lumbar spine surgery under GA, with a significant impact on QOL and ADLs. There is a need to research new strategies to reduce fatigue after spine surgery.
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Affiliation(s)
| | | | - Selby Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
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7
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Safa A, De Biase G, Gassie K, Garcia D, Abode-Iyamah K, Chen SG. Reliability of YouTube videos on robotic spine surgery for patient education. J Clin Neurosci 2023; 109:6-10. [PMID: 36634473 DOI: 10.1016/j.jocn.2022.12.014] [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: 11/01/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic surgical systems developed to improve spine surgery accuracy. Studies have found significant reductions in screw revisions and radiation exposure with robotic assistance compared with open surgery. YouTube is the largest online video platform for medical education. Therefore, there is a need for the continuous critical assessment of healthcare-related YouTube videos. Our objective is to assess the reliability of YouTube videos on robotic spine surgery for patient education. METHODS In April of 2022, YouTube was queried for the following keywords: "Robotic Spine Surgery". The "Relevance-Based Ranking" filter was applied, and the first 3 result pages were considered. Videos had to be uploaded by universities or hospitals and be in the English. Three independent healthcare personnel evaluated the videos' education quality using the DISCERN tool. RESULTS Our study found that 33 % of videos analyzed scored above a 3 on the DISCERN scoring scale (considered a ''good" video), with overall mean DISCERN score of 2.8 ± 1.3 (SD). The duration of videos was significantly different between the two groups (Good = 16 min ± 21 vs Unhelpful = 4 min ± 4, p = 0.01). In the helpful group, other characteristics were number of views (16331 ± 31308), likes (88 ± 168) and dislikes (5 ± 8). No statistically significant differences were observed compared to the unhelpful group: number of views (6515 ± 9074; P = 0.20), likes (39 ± 55; P = 0.21) and dislikes (3 ± 4; P = 0.33). CONCLUSION Our study shows that YouTube videos on robotic spine surgery lack accuracy and have poor educational value. There should be increased institutional oversight to combat the spread of misinformation.
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Affiliation(s)
- Adrian Safa
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kelly Gassie
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Diogo Garcia
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Selby G Chen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Kundu M, Abdulla E, Rahman MM. Letter: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition. Neurosurgery 2023; 92:e9. [PMID: 36399424 DOI: 10.1227/neu.0000000000002217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - Ebtesam Abdulla
- Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain
| | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
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De Biase G, Carter RE, Otamendi-Lopez A, Garcia D, Chen S, Bojaxhi E, Quinones-Hinojosa A, Abode-Iyamah K. Assessment of surgeons' attitude towards awake spine surgery under spinal anesthesia. J Clin Neurosci 2023; 107:48-53. [PMID: 36502781 DOI: 10.1016/j.jocn.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND General anesthesia (GA) and spinal anesthesia (SA) have been adopted for lumbar spine surgery (LSS), but GA is used far more widely. We conducted a survey of spine surgeons to explore their attitudes and preferences regarding awake spine surgery under SA. METHODS A survey was emailed to 150 spine surgeons. Exposure and attitudes towards spine surgery under SA were elicited. A five-point Likert scale of agreement examined perceptions of SA, while attitudes towards SA were recorded by categorizing free text into themes. RESULTS Seventy-five surgeons completed the survey, 50 % response rate. Only 27 % said they perform LSS under SA. Most surgeons, 83 %, would recommend GA to a healthy patient undergoing lumbar laminectomy. Only 41 % believes SA to be as safe as GA, and only 30 % believes SA is associated with better postoperative pain control. The most common reasons why SA is not favored was lack of proven benefits over GA (65 %). When asked if a randomized trial finds SA to lead to less postoperative fatigue, 50 % said they would be more likely to offer SA, a significant increase from the baseline response of 27 % (p = 0.002). CONCLUSIONS Our survey indicates that the low adoption of SA for LSS is due to lack of surgeons' belief in the benefits of SA over GA, and that a randomized patient-centered trial has the potential of changing surgeons' perspective and increasing adoption of SA for LSS.
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Affiliation(s)
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | | | - Diogo Garcia
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Selby Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
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Moniz-Garcia D, Stoloff D, Akinduro O, De Biase G, Sousa-Pinto B, Beeler C, Elder BD, Buchanan I, Abode-Iyamah K. Two- versus multi-rod constructs for adult spinal deformity: A systematic review and Random-effects and Bayesian meta-analysis. J Clin Neurosci 2023; 107:9-15. [PMID: 36459919 DOI: 10.1016/j.jocn.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical approaches in adult spinal deformity are associated with high rates of adverse events including hardware failure and rod fracture. Recently, some reports have emerged comparing multiple-rod constructs with 2-rod constructs suggesting potential benefits with the former. However, these have been limited by variability in observed outcomes, which have limited the change of paradigm in adult spinal deformity surgery. OBJECTIVE To compare the rate of rod fracture, pseudoarthrosis, proximal junctional kyphosis and re-operation between 2-RC and M-RC. METHODS MEDLINE/Pubmed, Web of Science and Embase were searched without language restrictions for relevant articles from inception until October 2021. All observational cohort studies assessing patients with ADS undergoing 3-column osteotomy and comparing 2-RC with M-RC procedures on pseudarthrosis, rod fracture, kyphosis or reoperation were included. Data were independently extracted by 2 authors. Random-effects and Bayesian meta-analysis were used. RESULTS Six primary studies met inclusion criteria, yielding a total of 448 participants, with 223 receiving 2-RC and 225 M-RC. The random-effects meta-analysis pointed to a significantly lower risk of rod fracture associated with M-RC (RR = 0.43, 95 %CI = 0.28-0.66), with moderate heterogeneity being observed (I2 = 20 %, p = 0.28). The random-effects meta-analysis pointed to a lower risk of pseudoarthrosis with M-RC than with 2-RC (RR = 0.49, CI = 0.28-0.84, to a lower rate of re-operation with M-RC than with 2-RC (RR = 0.52, CI = 0.28-0.97) and to a similar rate of proximal junctional kyphosis between 2-RC and M-RC patients (RR = 0.91, CI = 0.60-1.39). Low heterogeneity was observed for studies comparing pseudoarthrosis (I2 = 9 %, p = 0.35), re-operation (I2 = 0 %, p = 0.41) and proximal junctional kyphosis (I2 = 0 %, p = 0.85). DISCUSSION These findings suggest that multiple rod-fracture constructs are associated with lower rates of rod fracture, re-operation rates, pseudoarthrosis but not proximal junctional kyphosis. Future studies should address the impact of other modulators of heterogeneity such as body mass index, metal alloys and length of the constructs.
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Affiliation(s)
| | | | | | - Gaetano De Biase
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Cynthia Beeler
- Department of Medical Education, Mayo Clinic, Rochester, FL, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, FL, USA
| | - Ian Buchanan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
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11
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De Biase G, Gruenbaum SE, Quinones-Hinojosa A, Abode-Iyamah KO. In Reply: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition. Neurosurgery 2023; 92:e10. [PMID: 36346234 DOI: 10.1227/neu.0000000000002218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 02/03/2024] Open
Affiliation(s)
- Gaetano De Biase
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shaun E Gruenbaum
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
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12
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Gami P, Qiu K, Kannappan S, Alperin Y, Biase GD, Buchanan IA, Quiñones-Hinojosa A, Abode-Iyamah K. Semiautomated intraoperative measurement of Cobb angle and coronal C7 plumb line using deep learning and computer vision for scoliosis correction: a feasibility study. J Neurosurg Spine 2022; 37:713-721. [PMID: 36303475 DOI: 10.3171/2022.4.spine22133] [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: 01/28/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Scoliosis is a degenerative disease with a 3D deformity in the alignment of the spinal column. Surgical spinal correction outcomes are heavily dependent on the surgeon's expertise and use of visual cues because of time requirements, lack of automation, and radiation exposure associated with current intraoperative measurement techniques. In this study, the authors sought to validate a novel, nonradiographic, and semiautomated device that measures spinal alignment intraoperatively using deep learning and computer vision. METHODS To obtain spinal alignment metrics intraoperatively, the surgeon placed 3D-printed markers made of acrylonitrile butadiene styrene (ABS) plastic at designated locations in the surgical field. With the high-definition camera of the device, the surgeon can take an image of the markers in the surgical field. Images are processed through a computer vision model that detects the location of the markers and calculates the Cobb angle and coronal plumb line. The marker detection model was trained on 100 images and tested on 130 images of the ABS markers in various conditions. To verify the Cobb angle calculation, 50 models of angle templates from 0° to 180° in 3.6735° increments were created for testing. To verify the plumb line calculation, 21 models of plumb line measurements from -10 to +10 cm in increments of 1 cm were created for testing. A validation study was performed on a scoliotic cadaver model, and the radiographic calculations for Cobb angle and plumb line were compared with the device's calculations. RESULTS The area under the curve for the marker detection model was 0.979 for Cobb angle white, 0.791 for Cobb angle black, and 1 for the plumb line model. The average absolute difference between expected and measured Cobb angles on the verification models was 1.726° ± 1.259°, within the clinical acceptable error of 5°. The average absolute difference between the expected and measured plumb lines on the verification models was 0.415 ± 0.255 cm. For the cadaver validation study, the differences between the radiographic and device calculations for the Cobb angle and plumb line were 2.78° and 0.29 cm, respectively. CONCLUSIONS The authors developed and validated a nonradiographic, semiautomated device that utilizes deep learning and computer vision to measure spinal metrics intraoperatively.
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Affiliation(s)
- Parth Gami
- 1Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | - Kelly Qiu
- 1Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | - Sindhu Kannappan
- 1Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | - Yoel Alperin
- 1Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | | | - Ian A Buchanan
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
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Chen J, Wang J, Duan X, Ping F, Zhang A. Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9160145. [PMID: 36046452 PMCID: PMC9420591 DOI: 10.1155/2022/9160145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Objective This work is aimed at evaluating the efficacy and safety of general anesthesia (GA) combined with spinal anesthesia (SA) (GA+SA) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods and Material. 50 elderly COPD patients were rolled randomly into a control group (simple GA) and observation group (GA+SA). The differences in operation time, postoperative recovery time (PRT), language expression time (LET), anesthetic dosage (AD), catheter extubation time (CET), respiratory circulation indicators (mean arterial pressure (MAP), heart rate (HR), SaO2, and PaO2), postoperative VRS score, pulmonary function (forced vital capacity (FVC)), forced expiratory volume in 1 s (FEV1)/FVC and forced expiratory flow (FEF 25%~75%), serum inflammatory factors (IL-6, IL-8, and TNF-α), Short Portable Mental Status Questionnaire (SPMSQ) score, and the incidence of respiratory system events were analyzed. Results The results showed that the PRT, LET, AD, and CET of the observation group were all shorter (P < 0.05). The postoperative MAP, HR, SaO2, and PaO2 levels of patients who received GA+SA were much higher than those who received simple GA (P < 0.05). The postoperative VRS score of the observation group was better than that of the controls (P < 0.05). The postoperative pulmonary function of patients in the observation group was better compared with that in the control group (P < 0.05). The postoperative serum inflammatory factors in the observation group were lower in contrast to the patients who received simple GA (P < 0.05). The postoperative cognitive function SPMSQ score of patients who received GA+SA was lower compared with the score of patients who received simple GA (P < 0.05). However, the probability of respiratory system events in the observation group was lower (P < 0.05). Conclusion In conclusion, GA+SA could significantly shorten the PRT and improve the recovery quality of elderly COPD patients. It can also reduce the postoperative inflammatory response and strengthen the pulmonary function and cognitive function. It also enhances the analgesic which is beneficial to patients' postoperative recovery. Therefore, GA+SA was a highly effective and safe anesthesia method for elderly patients with COPD, and it was worthy of clinical application.
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Affiliation(s)
- Jie Chen
- Affiliated Hospital of Hebei Engineering University, Handan, 056002 Hebei, China
| | - Jing Wang
- Affiliated Hospital of Hebei Engineering University, Handan, 056002 Hebei, China
| | - Xiaohui Duan
- Affiliated Hospital of Hebei Engineering University, Handan, 056002 Hebei, China
| | - Fumin Ping
- Affiliated Hospital of Hebei Engineering University, Handan, 056002 Hebei, China
| | - Aiming Zhang
- Affiliated Hospital of Hebei Engineering University, Handan, 056002 Hebei, China
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SPECT-CT as a Predictor of Pain Generators in Patients Undergoing Intra-Articular Injections for Chronic Neck and Back Pain. World Neurosurg 2022; 164:e1243-e1250. [PMID: 35691522 DOI: 10.1016/j.wneu.2022.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ability to accurately predict pain generators for chronic neck and back pain remains elusive. OBJECTIVE We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography-computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain. METHODS A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level. RESULTS A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34-1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010). CONCLUSION This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections.
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Abbatematteo JM, Snyder LA. Commentary: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition. Neurosurgery 2022; 90:e174-e175. [PMID: 35384927 DOI: 10.1227/neu.0000000000001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joseph M Abbatematteo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cost of a Surgeon's Learning Curve. World Neurosurg 2021; 162:e1-e7. [PMID: 34785362 DOI: 10.1016/j.wneu.2021.11.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Minimally invasive transforaminal interbody fusion has become an increasingly common approach in adult degenerative spine disease but is associated with a steep learning curve. OBJECTIVE To evaluate the impact of the learning experience on mean procedure time and mean cost associated with each procedure. METHODS We studied the first one-hundred consecutive minimally invasive transforaminal interbody fusion procedures of a single surgeon. We performed multivariable linear regression models, modelling operating time and costs in function of the procedure order adjusted for patients' age, gender and number of surgical levels. The number of procedures necessary to attain proficiency was determined through a k-means cluster analysis. Finally, the total excess operative time and total excess cost until obtaining proficiency was evaluated. RESULTS Procedure order was found to impact procedure time and mean costs, with each successive case being associated with progressively less procedure time and cost. On average, each successive case was associated with a reduction in procedure time of 0.97 minutes (95% CI=0.54-1.40; p<0.001) and an average adjusted reduction in overall costs of $82.75 (95% CI=$35.93-129.57; p<0.001). An estimated 58 procedures were needed to attain proficiency, translating into an excess procedure time of 2604.2 minutes (average of 45 minutes per case), overall costs associated with the learning experience of $226,563.8 (average of $3974.80 per case), and excess surgical cost of $125,836.6 (average of $2207.66 per case). CONCLUSION Successive cases were associated with progressively less procedure time and mean overall and surgical costs, until a proficiency threshold was attained.
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