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Bauerle L, Wessell JE, Bindner S, Saway BF, Wolgamott L, Kalhorn SP. Use of Subfascial Passive Bile Bag Drainage for the Management of Durotomies in Spine Surgery. Cureus 2024; 16:e68397. [PMID: 39224492 PMCID: PMC11366417 DOI: 10.7759/cureus.68397] [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] [Accepted: 08/30/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Historically, the use of subfascial drains for the management of durotomies was avoided due to concerns about the creation of cerebrospinal fluid (CSF) fistulas. Currently, there are limited series utilizing subfascial drainage for CSF leak management, many of which utilize suction drainage. We report our experience with the use of subfascial passive drainage in the management of such leaks. OBJECTIVE To demonstrate the efficacy of a passive subfascial bile bag for diversion of CSF post-operatively in concert with a post-operative head of bed (HOB) protocol for the management of durotomies in spine surgery. METHODS We performed a retrospective chart review of patients who underwent spinal surgery at a single institution performed by one surgeon. Cases utilizing a passive subfascial bile bag for durotomies were identified. A total of 1,882 consecutive surgeries were reviewed, and 108 met the inclusion criteria. The primary outcome was return to the operating room (OR) and/or the need for lumbar drain placement. Patient sociodemographic information and pre-, intra-, and post-operative clinical characteristics were reviewed. RESULTS A total of 108 patients underwent subfascial bile bag CSF diversion after intra-operative durotomy. Four patients (3.7%) experienced post-operative CSF leakage requiring lumbar drain placement, while only two (1.9%) patients required a return to the OR. One patient returned to the OR for symptomatic pseudomeningocele and the other for ongoing CSF drainage from their wound. CONCLUSION Durotomies are known to increase complication rates, including reoperation. The use of subfascial passive bile bag drainage in concert with a post-operative HOB protocol is a safe and effective manner to manage durotomies while minimizing the need for reoperation.
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Affiliation(s)
- Luke Bauerle
- College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Jeffrey E Wessell
- Department of Neurosurgery, Neurosurgical and Spine Institute of Savannah, Savannah, USA
| | - Samantha Bindner
- College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Brian F Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
| | - Laura Wolgamott
- Department of Neurosurgery, Stanford Health Care, Palo Alto, USA
| | - Stephen P Kalhorn
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
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Prasse T, Heck VJ, Leyendecker J, Hofstetter CP, Kernich N, Eysel P, Bredow J. Economic Implications of Dural Tears in Lumbar Microdiscectomies: A Retrospective, Observational Study. World Neurosurg 2024; 188:e18-e24. [PMID: 38631663 DOI: 10.1016/j.wneu.2024.04.052] [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: 03/16/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Dural tears (DTs) are a frequent complication after lumbar spine surgery. We sought to determine the incidence of DTs and the related impact on health care expenditures after lumbar discectomies. METHODS In this retrospective cohort study, all patients with first-time single-level lumbar discectomies at our institution who underwent minimally invasive surgery from 2015 to 2019 were reviewed. Age, sex, weight, height, body mass index, costs, revenues, length of stay, American Society of Anesthesiologists score, Charlson Comorbidity Index, and operative time (OT) were assessed. Exclusion criteria were age <18 years, previous spine surgery, multiple or traumatic disc herniations, and malignant and infectious diseases. RESULTS The follow-up time was at least 12 months postoperatively. Of 358 patients identified with lumbar discectomies, 230 met the inclusion criteria. Incidence of DTs was 3.5%. Mean costs (P < 0.001), economic loss (P < 0.01), and OT (P < 0.0001) were found to be significantly higher in the DT group compared with the control group of patients without a DT. The revenues were not statistically different between the 2 groups (P > 0.05). Further analysis of the control group by profit and loss revealed significantly higher body mass index (P < 0.05), length of stay (P < 0.0001), and OT (P < 0.0001) in the loss group. CONCLUSIONS DTs represent a significant socioeconomic burden in lumbar spine surgery and cause severe secondary complications. The impact of DTs on health care expenses is primarily based on significantly higher OT and a higher mean length of stay.
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Affiliation(s)
- Tobias Prasse
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
| | - Vincent J Heck
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jannik Leyendecker
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
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El Husseini H, Chenisz da Silva JF, Giacomelli Leal A, Dering LM, Ramina R, Alves da Silva I, El Husseini M. Dural Closure Training With Prototyped Model. Cureus 2024; 16:e61688. [PMID: 38975561 PMCID: PMC11227629 DOI: 10.7759/cureus.61688] [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] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION The hermetic closure of the dura mater is a critical step in neurosurgical training, often undervalued but crucial to preventing serious complications such as cerebrospinal fluid (CSF) leaks leading to meningitis and death. Inadequate closure, often due to insufficient training, can result in challenging complications, including prolonged hospitalization and reoperation. OBJECTIVE To address the deficiencies in dural closure training, this study aims to describe a 3D prototype for simulating post-craniotomy dura mater suturing. The objective is to reduce the incidence of CSF leaks and improve the training of neurosurgery residents. DESIGN The study involves the creation of a 3D prototype based on magnetic resonance imaging and computed tomography scans. The additive manufacturing of structures is performed using ABS filament, and a silicone rubber membrane is used to simulate the meningeal dura mater. Neurosurgery residents undergo training using this model, and the effectiveness is evaluated. SETTING The study is conducted at the Institute of Neurology of Curitiba (Hospital INC), focusing on neurosurgery residents from the first to fifth year of residency. PARTICIPANTS Seven residents participate in the study, with varying levels of experience in dural closure procedures. The training involves a simulated surgical environment using the 3D prototype. RESULTS After training, residents show improvements in confidence and theoretical knowledge related to dural closure. Binary questions indicate a strong desire for more practical training on dural closure, with 85.7% believing in the essential role of 3D molds in their neurosurgery training. CONCLUSION The study highlights the importance of adequate training for dural closure to prevent serious complications in neurosurgery. The use of 3D simulation models, despite some limitations, proves to be an effective educational strategy. The emerging technology of bioprinting holds promise for further enhancing simulation materials, bringing medical education closer to realistic tissue replication.
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Affiliation(s)
| | | | | | - Lorena Maria Dering
- Technology and 3D Printing, Neurological Institute of Curitiba (Hospital INC), Curitiba, BRA
| | - Ricardo Ramina
- Neurosurgery, Neurological Institute of Curitiba (Hospital INC), Curitiba, BRA
| | - Igor Alves da Silva
- Neurosurgery, Neurological Institute of Curitiba (Hospital INC), Curitiba, BRA
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Yu H, Zhao Q, Lv J, Liu J, Zhu B, Chen L, Jing J, Tian D. Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors. Acta Neurochir (Wien) 2024; 166:95. [PMID: 38381267 PMCID: PMC10881605 DOI: 10.1007/s00701-024-05965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND An unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE. METHOD Data from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk. RESULTS Overall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT. CONCLUSIONS In this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.
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Affiliation(s)
- Hang Yu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
- Department of Orthopaedics, Huzhou Central Hospital, 313000, Huzhou, China
| | - Qingzhong Zhao
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Jianwei Lv
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Jianjun Liu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Bin Zhu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Lei Chen
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Juehua Jing
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Dasheng Tian
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China.
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Zielinski E, Beutler G, Hajewski CJ, Sasso R. A Subdural Dissection of Cerebrospinal Fluid Causing Cauda Equina Centralization After Durotomy: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00016. [PMID: 38241431 DOI: 10.2106/jbjs.cc.23.00444] [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: 01/21/2024]
Abstract
CASE A 61-year-old woman with recurrent left L5 radiculopathy underwent revision L4-5 decompression complicated by incidental durotomy requiring primary repair. Postoperative course was complicated by wound drainage and headache. Repeat magnetic resonance imaging demonstrated cerebrospinal fluid dissecting a plane deep to the dura mater but superficial to the arachnoid, with the collection compressing the cauda equina in an atypical horizontal and linear fashion. Nonoperative treatment was ineffective, and she required revision decompression and dural repair. CONCLUSION Spine surgeons should recognize this finding on postoperative imaging as a potential sign of an incomplete dural repair necessitating return to the operating room.
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Affiliation(s)
- Emily Zielinski
- Department of Orthopedic Surgery, IU Health University Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Graham Beutler
- Department of Orthopedic Surgery, IU Health University Hospital, Indiana University School of Medicine, Indianapolis, Indiana
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Schermann H, Hochberg U, Regev GJ, Salame K, Ofir D, Ankori R, Lidar Z, Khashan M. The effect of subcutaneous fat and skin-to-lamina distance on complications and functional outcomes of minimally invasive lumbar decompression. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05852-4. [PMID: 37249629 DOI: 10.1007/s00264-023-05852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Minimally invasive lumbar decompression (MIS) in obese pzatients is technically challenging due to the use of longer tube retractors. The purpose of this study was to evaluate the impact of the thickness of the soft tissue and subcutaneous fat on complications, revisions, and patient-reported functional outcomes after MIS. METHODS This is a retrospective analysis of 148 consecutive patients who underwent minimally invasive lumbar decompression at our institute between 2013 and 2017 and had at least one year of follow-up. Analysis was performed five times, each time the study group was defined by another measure of adiposity: BMI > 30, skin to lamina distance at the site of surgery and at L4 > 6 cm, and subcutaneous fat thickness at the site of surgery and at L4 > 3 cm. Outcomes included intraoperative complications (durotomy or neurological deficit), possibly inadequate decompression (residual disc, reoperation), length of stay, return to the emergency room or readmission, postoperative medical complications, and functional outcomes: visual analog scores for back and leg pain, and Oswestry Disability Index (ODI). RESULTS Patients with a thicker layer soft tissue had a significantly higher burden of comorbidities than controls, including higher prevalence of cardiovascular disease (p = 0.002), diabetes (p < 0.001), hypertension (p < 0.001) and higher ASA scores (p = 0.002). Nevertheless, there was no significant difference between the patient groups in surgical and medical complications, functional outcomes, and other assessed outcomes. CONCLUSION Our results indicate that minimally invasive lumbar decompression is safe and effective for patients with a thick layer of soft tissue and subcutaneous fat.
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Affiliation(s)
- Haggai Schermann
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Uri Hochberg
- Pain Clinic, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Gilad J Regev
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Dror Ofir
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Ankori
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Zvi Lidar
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Morsi Khashan
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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Dong RP, Zhang Q, Yang LL, Cheng XL, Zhao JW. Clinical management of dural defects: A review. World J Clin Cases 2023; 11:2903-2915. [PMID: 37215425 PMCID: PMC10198091 DOI: 10.12998/wjcc.v11.i13.2903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Dural defects are common in spinal and cranial neurosurgery. A series of complications, such as cerebrospinal fluid leakage, occur after rupture of the dura. Therefore, treatment strategies are necessary to reduce or avoid complications. This review comprehensively summarizes the common causes, risk factors, clinical complications, and repair methods of dural defects. The latest research progress on dural repair methods and materials is summarized, including direct sutures, grafts, biomaterials, non-biomaterial materials, and composites formed by different materials. The characteristics and efficacy of these dural substitutes are reviewed, and these materials and methods are systematically evaluated. Finally, the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.
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Affiliation(s)
- Rong-Peng Dong
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Qi Zhang
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Li-Li Yang
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xue-Liang Cheng
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Jian-Wu Zhao
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
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Usevitch DE, Bronheim RS, Reyes MC, Babilonia C, Margalit A, Jain A, Armand M. Review of Enhanced Handheld Surgical Drills. Crit Rev Biomed Eng 2023; 51:29-50. [PMID: 37824333 PMCID: PMC10874117 DOI: 10.1615/critrevbiomedeng.2023049106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The handheld drill has been used as a conventional surgical tool for centuries. Alongside the recent successes of surgical robots, the development of new and enhanced medical drills has improved surgeon ability without requiring the high cost and consuming setup times that plague medical robot systems. This work provides an overview of enhanced handheld surgical drill research focusing on systems that include some form of image guidance and do not require additional hardware that physically supports or guides drilling. Drilling is reviewed by main contribution divided into audio-, visual-, or hardware-enhanced drills. A vision for future work to enhance handheld drilling systems is also discussed.
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Affiliation(s)
- David E. Usevitch
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, United States
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel S. Bronheim
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Miguel C. Reyes
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Carlos Babilonia
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Adam Margalit
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Mehran Armand
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, United States
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, United States
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Verma K, Freelin AH, Atkinson KA, Graham RS, Broaddus WC. Early mobilization versus bed rest for incidental durotomy: an institutional cohort study. J Neurosurg Spine 2022; 37:460-465. [PMID: 35303709 DOI: 10.3171/2022.1.spine211208] [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: 09/11/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether flat bed rest for > 24 hours after an incidental durotomy improves patient outcome or is a risk factor for medical and wound complications and longer hospital stay. METHODS Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures from 2010 to 2020 were reviewed. Operative notes and progress notes were reviewed and searched to identify patients in whom incidental durotomies occurred. The need for revision surgery related to CSF leak or wound infection was recorded. The duration of bed rest, length of hospital stay, and complications (pulmonary, gastrointestinal, urinary, and wound) were recorded. The rates of complications were compared with regard to the duration of bed rest (≤ 24 hours vs > 24 hours). RESULTS A total of 420 incidental durotomies were identified, indicating a rate of 6.7% in the patient population. Of the 420 patients, 361 underwent primary repair of the dura; 254 patients were prescribed bed rest ≤ 24 hours, and 107 patients were prescribed bed rest > 24 hours. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, p = 0.86) between the two groups, but wound complications were increased in the prolonged bed rest group (8.66% vs 15.89%, p = 0.043). The average length of stay for patients with bed rest ≤ 24 hours was 4.47 ± 3.64 days versus 7.24 ± 4.23 days for patients with bed rest > 24 hours (p < 0.0001). There was a statistically significant increase in the frequency of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bed rest after an incidental durotomy. The relative risk of complications in the group with bed rest ≤ 24 hours was 50% less than the group with > 24 hours of bed rest (RR 0.5, 95% CI 0.39-0.62; p < 0.0001). CONCLUSIONS In this retrospective study, the rate of revision surgery was not higher in patients with durotomy who underwent immediate mobilization, and medical complications were significantly decreased. Flat bed rest > 24 hours following incidental durotomy was associated with increased length of stay and increased rate of medical complications. After primary repair of an incidental durotomy, flat bed rest may not be necessary and appears to be associated with higher costs and complications.
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Bacco L, Russo F, Ambrosio L, D’Antoni F, Vollero L, Vadalà G, Dell’Orletta F, Merone M, Papalia R, Denaro V. Natural language processing in low back pain and spine diseases: A systematic review. Front Surg 2022; 9:957085. [PMID: 35910476 PMCID: PMC9329654 DOI: 10.3389/fsurg.2022.957085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Natural Language Processing (NLP) is a discipline at the intersection between Computer Science (CS), Artificial Intelligence (AI), and Linguistics that leverages unstructured human-interpretable (natural) language text. In recent years, it gained momentum also in health-related applications and research. Although preliminary, studies concerning Low Back Pain (LBP) and other related spine disorders with relevant applications of NLP methodologies have been reported in the literature over the last few years. It motivated us to systematically review the literature comprised of two major public databases, PubMed and Scopus. To do so, we first formulated our research question following the PICO guidelines. Then, we followed a PRISMA-like protocol by performing a search query including terminologies of both technical (e.g., natural language and computational linguistics) and clinical (e.g., lumbar and spine surgery) domains. We collected 221 non-duplicated studies, 16 of which were eligible for our analysis. In this work, we present these studies divided into sub-categories, from both tasks and exploited models’ points of view. Furthermore, we report a detailed description of techniques used to extract and process textual features and the several evaluation metrics used to assess the performance of the NLP models. However, what is clear from our analysis is that additional studies on larger datasets are needed to better define the role of NLP in the care of patients with spinal disorders.
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Affiliation(s)
- Luca Bacco
- Department of Engineering, Unit of Computer Systems and Bioinformatics, Campus Bio-Medico University of Rome, Rome, Italy
- ItaliaNLP Lab, National Research Council, Istituto di Linguistica Computazionale “Antonio Zampolli”, Pisa, Italy
- R&D Lab, Webmonks S.r.l., Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Correspondence: Mario Merone Fabrizio Russo
| | - Luca Ambrosio
- Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Federico D’Antoni
- Department of Engineering, Unit of Computer Systems and Bioinformatics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Vollero
- Department of Engineering, Unit of Computer Systems and Bioinformatics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Felice Dell’Orletta
- ItaliaNLP Lab, National Research Council, Istituto di Linguistica Computazionale “Antonio Zampolli”, Pisa, Italy
| | - Mario Merone
- Department of Engineering, Unit of Computer Systems and Bioinformatics, Campus Bio-Medico University of Rome, Rome, Italy
- Correspondence: Mario Merone Fabrizio Russo
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Rome, Italy
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Nielsen TH, Rasmussen MM, Thygesen MM. Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc. Acta Neurochir (Wien) 2022; 164:1883-1888. [PMID: 35641649 DOI: 10.1007/s00701-022-05259-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Incidental durotomy (ID) is one of the most common complications in degenerative surgery. Due to the negative consequences of ID, knowledge about incidence and risk factors is warranted. METHODS A total of 1,139 surgical procedures for lumbar spinal stenosis (LS) and lumbar herniated disc (LDH) were included from the spine surgery database: DaneSpine. Uni- and multivariate analyses were performed for the assessment of possible risk factors. RESULTS ID occurred in 10.4% of the surgical procedures. A multivariate regression analysis revealed an increased relative risk of ID by 2% per year of age, 58% by revision surgery, and 55% by decompression on multiple levels. CONCLUSION In our single-centre cohort study, one in ten patients experiences an ID. Increasing age, revision surgery and decompression of multiple levels are risk factors of ID in degenerative surgery of the lumbar spine.
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Affiliation(s)
- Teresa Haugaard Nielsen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Mathias Møller Thygesen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis. Medicina (B Aires) 2021; 57:medicina57111270. [PMID: 34833488 PMCID: PMC8622409 DOI: 10.3390/medicina57111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally invasive (MIS) tubular decompression without arthrodesis in patients suffering from LSS with or without concomitant stable low-grade degenerative spondylolisthesis. Materials and Methods: This study is a retrospective review of prospectively collected data. Ninety-six consecutive patients who underwent elective MIS lumbar decompression with a mean follow-up of 27.5 months were included in the study. The spondylolisthesis (S) group comprised 53 patients who suffered from LSS with stable degenerative spondylolisthesis, and the control (N) group included 43 patients suffering from LSS without spondylolisthesis. Outcome measures included complications and revision surgery rates. Pre- and post-operative visual analog scale (VAS) for both back and leg pain was analyzed, and the Oswestry Disability Index (ODI) was used to evaluate functional outcome. Results: The two groups were comparable in most demographic and preoperative variables. VAS for back and leg pain improved significantly following surgery in both groups. Both groups showed significant improvement in their ODI scores, at one and two years postoperatively. The average length of hospital stay was significantly higher in patients with spondylolisthesis (p-value< 0.01). There was no significant difference between the groups in terms of post-operative complications rates or re-operation rates. Conclusions: Our results indicate that MIS tubular decompression may be an effective and safe procedure for patients suffering from LSS, with or without degenerative stable spondylolisthesis.
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Al-Gethami H, Cenic A, Kachur E. Seizures following cervical laminectomy and lateral mass fusion: case report and review of the literature. JOURNAL OF SPINE SURGERY 2021; 7:445-455. [PMID: 34734149 DOI: 10.21037/jss-20-642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
Incidental durotomy can occur as a complication of spine surgery, which may potentially result in serious intracranial complications. We report a case of a 72 years old male with significant cervical spinal stenosis from C3 to C5 with spinal cord myelomalacia who underwent a posterior cervical decompression with instrumentation and fusion from C3-C5. An incidental dural tear was encountered during the surgery, with a sudden gush of cerebrospinal fluid (CSF) managed intraoperatively. Unfortunately, he developed generalized tonic-clonic seizures subsequently in the immediate post-operative period. Computerized tomography (CT) scan was urgently done which revealed intracranial pneumocephalus, subarachnoid hemorrhage and a right acute subdural hematoma. This case illustrates the intracranial hemorrhage potential subsequent to iatrogenic dural tear and CSF leak manifested by generalized seizures. The repair of incidental durotomy should be done immediately to decrease the amount of CSF leak and prevent any devastating effects of intracranial hemorrhage. The mechanism of this type of bleeding, risk factors and appropriate management are discussed, along with a review of the literature.
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Affiliation(s)
- Hanan Al-Gethami
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Edward Kachur
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
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Shenoy K, Donnally CJ, Sheha ED, Khanna K, Prasad SK. An Investigation of a Novel Dural Repair Device for Intraoperative Incidental Durotomy Repair. Front Surg 2021; 8:642972. [PMID: 34291076 PMCID: PMC8288282 DOI: 10.3389/fsurg.2021.642972] [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: 12/17/2020] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair time, CSF leak pressure and nerve root avoidance in the simulation. The results were generally replicable clinically, however, numerous additional clinical scenarios were also encountered that the simulation model was unable to capture due to various inherent limitations. The simulation model design, potential contributors to watertightness, clinical experiences, and limitation are discussed.
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Affiliation(s)
- Kartik Shenoy
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, United States
| | - Chester J Donnally
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, United States
| | - Evan D Sheha
- Institute for Spine Care, Chicago Institute of Neurosurgery and Neuroresearch, Rush Presbyterian Medical Center, Chicago, IL, United States
| | - Krishn Khanna
- Institute for Spine Care, Chicago Institute of Neurosurgery and Neuroresearch, Rush Presbyterian Medical Center, Chicago, IL, United States
| | - Srinivas K Prasad
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, PA, United States
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Shahrestani S, Bakhsheshian J, Chen XT, Ton A, Ballatori AM, Strickland BA, Robertson DM, Buser Z, Hah R, Hsieh PC, Liu JC, Wang JC. The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis. EClinicalMedicine 2021; 36:100889. [PMID: 34308307 PMCID: PMC8257994 DOI: 10.1016/j.eclinm.2021.100889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented. There exists a paucity of studies that comprehensively analyze MRF subgroups and their independent association with postoperative complications in patients undergoing cervical spine surgery. Therefore, the purpose of this study is to compare outcomes between patients receiving cervical spine surgery with reported MRFs. METHODS Retrospective analysis of the Nationwide Readmissions Database (NRD) from the years 2016 and 2017, a publicly available and purchasable data source, to include adult patients undergoing cervical fusion. MRF cohorts were separated into three categories: substance abuse (alcohol, tobacco/nicotine, opioid abuse); vascular disease (hypertension, dyslipidemia); and dietary factors (malnutrition, obesity). Three-way nearest-neighbor propensity score matching for demographics, hospital, and surgical characteristics was implemented. FINDINGS We identified 9601 with dietary MRFs (D-MRF), 9654 with substance abuse MRFs (SA-MRF), and 9503 with vascular MRFs (V-MRF). Those with d-MRFs had significantly higher rates of medical complications (9.3%), surgical complications (8.1%), and higher adjusted hospital costs compared to patients with SA-MRFs and V-MRFs. Patients with d-MRFs (16.3%) and V-MRFs (14.0%) were independently non-routinely discharged at a significantly higher rate compared to patients with SA-MRFs (12.6%) (p<0.0001 and p = 0.0037). However, those with substance abuse had the highest readmission rate and were more commonly readmitted for delayed procedure-related infections. INTERPRETATION A large proportion of patients who receive cervical spine surgery have potential MRFs that uniquely influence their postoperative outcomes. A thorough understanding of patient-specific MRF subgroups allows for improved preoperative risk stratification, tailored patient counseling, and postoperative management planning. FUNDING None.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States
- Corresponding author at: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Xiao T. Chen
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander M. Ballatori
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ben A. Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Djani M. Robertson
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, United States
| | - Zorica Buser
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Patrick C. Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John C. Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jeffrey C. Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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16
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Shahmohammadi M, Hajimohammadebrahim-Ketabforoush M, Behnaz F, Keykhosravi E, Zandpazandi S. Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear. Int J Spine Surg 2021; 15:429-435. [PMID: 33985999 DOI: 10.14444/8064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Incidental durotomies (IDs) are frequent complications of spinal surgeries which are mostly posterior or lateral. Anterior IDs are rare; however, they may lead to severe complications. We compared the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear to assess the efficacy of these approaches to decrease postsurgical complications and clinical outcomes. METHODS A total of 21 patients undergoing L2-S1 laminectomy with anterior ID were randomly divided into a transthecal group (n = 9) and a conservative group (n = 12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, cerebrospinal fluid (CSF) leakage, headache, meningitis, in addition to surgery duration and length of hospitalization were examined and compared in both groups. RESULTS The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P = .045 and .008, respectively). Furthermore, although the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the 2 groups, the effect sizes of the comparison were obtained as 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the 2 groups. CONCLUSIONS We found that the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes. However, further clinical trials with bigger sample sizes are needed to substantiate this claim.
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Affiliation(s)
- Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Melika Hajimohammadebrahim-Ketabforoush
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faranak Behnaz
- Anesthesiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Zandpazandi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alshameeri ZAF, Jasani V. Risk Factors for Accidental Dural Tears in Spinal Surgery. Int J Spine Surg 2021; 15:536-548. [PMID: 33986000 DOI: 10.14444/8082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors. METHODS A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria. RESULTS Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4-7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49-3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84-2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50-2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01-1.93). The overall effects of sex and obesity were not statistically significant. CONCLUSION Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery. CLINICAL RELEVANCE Risk of dural tear during spine surgery.
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Affiliation(s)
- Zeiad A F Alshameeri
- University Hospital of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Vinay Jasani
- University Hospital of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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18
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Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management. J Am Acad Orthop Surg 2021; 29:e279-e286. [PMID: 33539059 DOI: 10.5435/jaaos-d-20-00210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/14/2020] [Indexed: 02/01/2023] Open
Abstract
Incidental durotomy (ID) can occur in up to 14% of all lumbar spine surgeries. The risk of this complication is markedly higher among elderly patients with advanced spinal pathology. In addition, revision cases and other more invasive procedures increase the risk of ID. When unrepaired, IDs can increase the risk of developing meningitis and can lead to the formation of cerebrospinal fluid fistulas and pseudomeningoceles. Intraoperative recognition and repair are essential to ID management, although repair techniques vary considerably. Although primary suture repair is considered the "benchmark," indirect repair alone has shown comparable outcomes. Given the concern for infection after ID, many have indicated for prolonged prophylactic antibiotic regimens. However, there is little clinical evidence that this is necessary after adequate repair. The addition of subfascial drains have been shown to promote wound healing and early ambulation, whereas no consensus on duration of indwelling drains exists and such management is largely case dependent. Early ambulation after surgery has not shown to be associated with increased risk of further ID complications and decreases rehabilitation time, length of stay, and risk of venous thromboembolism. However, there remains a role for conservation mobilization protocols in more severe cases where notable symptoms are observed.
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19
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Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies. World Neurosurg 2020; 139:e13-e22. [DOI: 10.1016/j.wneu.2020.01.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
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20
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Sheinis D, Sheinis V, Benharroch D, Ohana N. Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach. J Neurol Surg A Cent Eur Neurosurg 2020; 81:399-403. [PMID: 32588413 DOI: 10.1055/s-0039-1698390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Incidental durotomy is an intraoperative complication that occurs in 3 to 27% of lumbar spine surgeries. It has been reported more commonly following revision spinal procedures. STUDY OBJECTIVES To investigate the frequency of incidental durotomy while performing transforaminal lumbar interbody fusion (TLIF) using the modified Wiltse approach. A secondary goal was to compare the incidence of durotomy in patients undergoing primary spine surgery with those undergoing revision surgery. METHODS A group of consecutive patients who had undergone (TLIF) in the last 10 years ending in 2015 were enrolled in the study. All patients underwent TLIF via the modified Wiltse approach that included a central midline skin incision, followed by a paravertebral blunt dissection of the paraspinal muscles to reach the transverse processes. The deep paravertebral dissection was done conservatively, one side at a time. Demographic and clinical data were collected when relevant to the comparison. RESULTS The study cohort encompassed 257 patients: 200 primary cases and 57 revisions. The frequency of incidental durotomy was equal in both groups: 3.5% each (7/200 and 2/57). All durotomies were repaired primarily. No other immediate or late complications were observed during follow-up. CONCLUSION The present study displays a limited incidence of durotomy in the primary interventions and to a lesser degree in the revisions, all of which had used a TLIF performed with the modified Wiltse approach. This procedure probably circumvented the need for further revisions.
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Affiliation(s)
- Dimitri Sheinis
- Department of Orthopaedics, Soroka University, Beer Sheva, Southern, Israel
| | - Vadim Sheinis
- Department of Orthopaedics, Assaf Harofeh Medical Centre, Be'er Ya'akov, Israel
| | - Daniel Benharroch
- Department of Pathology, Soroka University, Beer Sheva, Southern, Israel.,Department of Pathology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Nissim Ohana
- Department of Orthopaedics, Meir Medical Center, Kfar Saba, Israel
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21
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Natural language processing for automated detection of incidental durotomy. Spine J 2020; 20:695-700. [PMID: 31877390 DOI: 10.1016/j.spinee.2019.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Incidental durotomy is a common intraoperative complication during spine surgery with potential implications for postoperative recovery, patient-reported outcomes, length of stay, and costs. To our knowledge, there are no processes available for automated surveillance of incidental durotomy. PURPOSE The purpose of this study was to develop natural language processing (NLP) algorithms for automated detection of incidental durotomies in free-text operative notes of patients undergoing lumbar spine surgery. PATIENT SAMPLE Adult patients 18 years or older undergoing lumbar spine surgery between January 1, 2000 and June 31, 2018 at two academic and three community medical centers. OUTCOME MEASURES The primary outcome was defined as intraoperative durotomy recorded in free-text operative notes. METHODS An 80:20 stratified split was undertaken to create training and testing populations. An extreme gradient-boosting NLP algorithm was developed to detect incidental durotomy. Discrimination was assessed via area under receiver-operating curve (AUC-ROC), precision-recall curve, and Brier score. Performance of this algorithm was compared with current procedural terminology (CPT) and international classification of diseases (ICD) codes for durotomy. RESULTS Overall, 1,000 patients were included in the study and 93 (9.3%) had a recorded incidental durotomy in the free-text operative report. In the independent testing set (n=200) not used for model development, the NLP algorithm achieved AUC-ROC of 0.99 for detection of durotomy. In comparison, the CPT/ICD codes had AUC-ROC of 0.64. In the testing set, the NLP algorithm detected 16 of 18 patients with incidental durotomy (sensitivity 0.89) whereas the CPT and ICD codes detected 5 of 18 (sensitivity 0.28). At a threshold of 0.05, the NLP algorithm had specificity of 0.99, positive predictive value of 0.89, and negative predictive value of 0.99. CONCLUSIONS Internal validation of the NLP algorithm developed in this study indicates promising results for future NLP applications in spine surgery. Pending external validation, the NLP algorithm developed in this study may be used by entities including national spine registries or hospital quality and safety departments to automate tracking of incidental durotomies.
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22
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Badiee RK, Mayer R, Pennicooke B, Chou D, Mummaneni PV, Tan LA. Complications following posterior cervical decompression and fusion: a review of incidence, risk factors, and prevention strategies. JOURNAL OF SPINE SURGERY 2020; 6:323-333. [PMID: 32309669 DOI: 10.21037/jss.2019.11.01] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Posterior cervical decompression and fusion (PCF) is a common surgical technique used to treat various cervical spine pathologies. However, there are various complications associated with PCF that can negatively impact patient outcome. We performed a comprehensive literature review to identify the most common complications following PCF using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The overall complication rates of PCF are estimated to range from about 15% to 25% in the current literature. The most common immediate complications include acute blood loss anemia, surgical site infection (SSI), C5 palsy, and incidental durotomy; the most common long-term complications include adjacent segment degeneration, junctional kyphosis, and pseudoarthrosis. Three principal mechanisms are thought to contribute to complications. First, higher number of fusion levels, obesity, and more complex pathologies can increase the invasiveness of the planned procedure, thus increase complications. Second, wound healing and arthrodesis may be impaired due to poor blood flow due to various patient factors such as smoking, diabetes, increased frailty, steroid use, and other medical comorbidities. Finally, increased biomechanical stress on the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) may predispose patient to chronic degeneration and result in adjacent level degeneration and/or junctional problems. Reducing the modifiable risk factors pre-operatively can decrease the overall complication rate. Neurologic deficits may be reduced with adequate intraoperative decompression of neural elements. SSI may be reduced with meticulous wound closure that minimizes dead space, drain placement, and the use of intra-wound antibiotics. Careful design of the fusion construct with consideration in spinal alignment and biomechanics can help to reduce the rate of junctional problems. Spine surgeons should be aware of these complications associated with PCF and the corresponding prevention strategies optimize patient outcomes.
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Affiliation(s)
- Ryan K Badiee
- School of Medicine, University of California, San Francisco, CA, USA
| | - Rory Mayer
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Dean Chou
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
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Kim W, Kim SK, Kang SS, Park HJ, Han S, Lee SC. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir (Wien) 2020; 162:279-287. [PMID: 31820196 DOI: 10.1007/s00701-019-04162-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Spinal percutaneous biportal endoscopic surgery (PBES) is a minimally invasive surgery; however, it is associated with several poor outcomes. This study aimed to analyze unsuccessful PBES outcomes and verify their relationships with patient satisfaction. METHODS From May 2015 to June 2018, PBES was performed at several institutions. Unsuccessful outcomes (reoperation and prolonged hospital stay) due to various reasons (hematoma, lesion recurrence, incomplete decompression, dural tear, instability, ascites, and infection) were analyzed. To verify the relationships between surgical experience and unsuccessful outcomes, the first 50 cases and the later cases were compared. Logistic regression was used to assess the relationships between unsuccessful outcomes and patient dissatisfaction. RESULTS Among 866 patients, 797 cases with 1-year follow-up and complete data were analyzed. In total, 82 patients with unsuccessful outcomes were identified (10.29%). The incidences of hematoma (p < 0.04), incomplete operation (p < 0.01), and dural tear (p < 0.01) were significantly higher in the first 50 cases than in the later cases. Analyses of the relationship between unsuccessful outcomes and patient dissatisfaction showed that incomplete decompression (odds ratio (OR) 4.06), postoperative instability (OR 3.64), hematoma (OR 3.25), ascite (OR 3.25), dural tear (OR 3.02), and local recurrence (OR 2.45, 95%) contributed significantly. CONCLUSIONS Unsuccessful PBES outcomes were mostly associated with hematomas, incomplete decompression, and dural tears; instability, ascites, and infection contributed to a lesser extent. Incomplete decompression, instability, hematoma, ascite, dural tear, and local recurrence were significantly related to patient dissatisfaction. The potential for poor outcomes should be described to the patient and considered prior to surgery.
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Affiliation(s)
- Wanseok Kim
- Department of Spine Center, Orthopaedic Surgery, Daechan Hospital, Incheon, South Korea
| | - Seung-Kook Kim
- Himchan UHS Spine and Joint Centre, Neurosurgery, University Hospital Sharjah, Sharjah, United Arab Emirates.
- Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea.
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul, South Korea.
| | - Sang-Soo Kang
- Department of Spine Center, Orthopaedic Surgery, Leaders Hospital, Seoul, South Korea
| | - Hyun-Jin Park
- Department of Spine Center, Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Sangho Han
- Department of Spine Center, Orthopaedic Surgery, Daechan Hospital, Incheon, South Korea
| | - Su-Chan Lee
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul, South Korea
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Tong YJ, Liu JH, Fan SW, Zhao FD. One-stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series. Orthop Surg 2019; 11:1109-1119. [PMID: 31701667 PMCID: PMC6904647 DOI: 10.1111/os.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Surgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis. Methods This was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively. Results The mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05). Conclusion One‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.
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Affiliation(s)
- Yong-Jun Tong
- Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China.,Department of Orthopaedics, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jun-Hui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
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25
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Sakamoto T, Abe K, Orita S, Inage K, Suzuki M, Fujimoto K, Shiga Y, Kanamoto H, Inoue M, Kinoshita H, Norimoto M, Umimura T, Eguchi Y, Takahashi K, Ohtori S. Three cases of adjacent segment disease post-posterior spinal fusion, treated successfully by oblique lateral interbody fusion: A clinical series. Clin Case Rep 2019; 7:206-210. [PMID: 30656043 PMCID: PMC6332745 DOI: 10.1002/ccr3.1957] [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: 08/05/2018] [Revised: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 11/09/2022] Open
Abstract
The incidence of spinal fusion surgery and associated adjacent segment disease (ASD) is steadily increasing. We report three cases of ASD after posterior fixation, treated by oblique lateral interbody fusion (OLIF). All cases had a good postoperative course. Altogether, OLIF surgery may be a viable option for treating ASD.
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Affiliation(s)
- Takuya Sakamoto
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Koki Abe
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Sumihisa Orita
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Kazuhide Inage
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Miyako Suzuki
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Kazuki Fujimoto
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Yasuhiro Shiga
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Hirohito Kanamoto
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Masahiro Inoue
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Hideyuki Kinoshita
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Masaki Norimoto
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Tomotaka Umimura
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Yawara Eguchi
- National Hospital Organization Shimoshizu HospitalYotsukaido cityChibaJapan
| | - Kazuhisa Takahashi
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
| | - Seiji Ohtori
- Department of Orthopaedic SurgeryChiba university hospital, Chiba UniversityChibaJapan
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