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Stanton E, Buser Z, Mesregah MK, Hu K, Pickering TA, Schafer B, Hah R, Hsieh P, Wang JC, Liu JC. The impact of enhanced recovery after surgery (ERAS) on opioid consumption and postoperative pain levels in elective spine surgery. Clin Neurol Neurosurg 2024; 242:108350. [PMID: 38788543 DOI: 10.1016/j.clineuro.2024.108350] [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: 03/27/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Enhanced Recovery after Surgery (ERAS) protocols were developed to counteract the adverse effects of the surgical stress response, aiming for quicker postoperative recovery. Initially applied in abdominal surgeries, ERAS principles have extended to orthopedic spine surgery, but research in this area is still in its infancy. The current study investigated the impact of ERAS on postoperative pain and opioid consumption in elective spine surgeries. METHODS A single-center retrospective study of patients undergoing elective spine surgery from May 2019 to July 2020. Patients were categorized into two groups: those enrolled in the ERAS pathway and those adhering to traditional surgical protocols. Data on demographics, comorbidities, length of stay (LOS), surgical procedures, and postoperative outcomes were collected. Postoperative pain was evaluated using the Numerical Rating Scale (NRS), while opioid utilization was quantified in morphine milligram equivalents (MME). NRS and MME were averaged for each patient across all days under observation. Differences in outcomes between groups (ERAS vs. treatment as usual) were tested using the Wilcoxon rank sum test for continuous variables and Pearson's or Fisher's exact tests for categorical variables. RESULTS The median of patient's mean daily NRS scores for postoperative pain were not statistically significantly different between groups (median = 5.55 (ERAS) and 5.28 (non-ERAS), p=.2). Additionally, the median of patients' mean daily levels of MME were similar between groups (median = 17.24 (ERAS) and 16.44 (non-ERAS), p=.3) ERAS patients experienced notably shorter LOS (median=2 days) than their non-ERAS counterparts (median=3 days, p=.001). The effect of ERAS was moderated by whether the patient had ACDF surgery. ERAS (vs. non-ERAS) patients who had ACDF surgery had 1.64 lower average NRS (p=.006). ERAS (vs. non-ERAS) patients who had a different surgery had 0.72 higher average NRS (p=.02) but had almost half the length of stay, on average (p<.001). CONCLUSIONS The current study underscores the dynamic nature of ERAS protocols within the realm of spine surgery. While ERAS demonstrates advantages such as reduced LOS and improved patient-reported outcomes, it requires careful implementation and customization to address the specific demands of each surgical discipline. The potential to expedite recovery, optimize resource utilization, and enhance patient satisfaction cannot be overstated. However, the fine balance between achieving these benefits and ensuring comprehensive patient care, especially in the context of postoperative pain management, must be maintained. As ERAS continues to evolve and find its place in diverse surgical domains, it is crucial for healthcare providers to remain attentive to patient needs, adapting ERAS protocols to suit individual patient populations and surgical contexts.
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Affiliation(s)
- Eloise Stanton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Zorica Buser
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States; Department of Orthopedic Surgery, Grossman School of Medicine, New York University, New York, United States; Gerling Institute, Brooklyn, NY, United States.
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Kelly Hu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Betsy Schafer
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Patrick Hsieh
- Department of Orthopedic Surgery, Grossman School of Medicine, New York University, New York, United States
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - John C Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Muthu S, Mavrovounis G, Corluka S, Buser Z, Brodano GB, Wu Y, Meisel HJ, Wang J, Yoon ST, Demetriades AK. Does the choice of chemoprophylaxis affect the prevention of deep vein thrombosis in lumbar fusion surgery? A systematic review of the literature. BRAIN & SPINE 2023; 3:102711. [PMID: 38021015 PMCID: PMC10668088 DOI: 10.1016/j.bas.2023.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
Introduction To date, the available guidance on venous thromboembolism (VTE) prevention in elective lumbar fusion surgery is largely open to surgeon interpretation and preference without any specific suggested chemoprophylactic regimen. Research question This study aimed to comparatively analyze the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of commonly employed chemoprophylactic agents such as unfractionated heparin (UH) and low molecular weight heparin (LMWH) in lumbar fusion surgery. Material and methods An independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting on DVT/PE outcomes of lumbar fusion surgery in adult patients with UH or LMWH chemoprophylaxis were included for analysis. Analysis was performed using the Stata software. Results Twelve studies with 8495 patients were included in the analysis. A single-arm meta-analysis of the included studies found a DVT incidence of 14% (95%CI [8%-20%]) and 1% (95%CI [-6% - 8%]) with LMWH and UH respectively. Both the chemoprophylaxis agents prevented PE with a noted incidence of 0% (95%CI [0%-0.1%]) and 0% (95%CI [0%-1%]) with LMWH and UH respectively. The risk of bleeding-related complications with the usage of LMWH and UH was 0% (95% CI [0.0%-0.30%]) and 3% (95% CI [0.3%-5%]) respectively. Discussion and conclusion Both LMWH and UH reduces the overall incidence of DVT/PE, but there is a paucity of evidence analyzing the comparative effectiveness of the chemoprophylaxis regimens in lumbar fusion procedures. The heterogeneity in data prevents any conclusions, as there remains an evidence gap. We recommend future high-quality randomized controlled trials to investigate in this regard to help develop recommendations on thromboprophylaxis usage.
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Affiliation(s)
- Sathish Muthu
- Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Georgios Mavrovounis
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stipe Corluka
- Spinal surgery Division, Department of Traumatology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | | | - Yabin Wu
- Research Department, AO Spine International, Davos, Switzerland
| | | | - Jeffrey Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA
| | - S. Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Andreas K. Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary Edinburgh, UK
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Resnick DK, Schmidt BT. Update on Spinal Fusion. Neurol Clin 2022; 40:261-268. [DOI: 10.1016/j.ncl.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lepard JR, Walters BC. A Bibliometric Analysis of Neurosurgical Practice Guidelines. Neurosurgery 2020; 86:605-614. [PMID: 31264698 DOI: 10.1093/neuros/nyz240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 04/06/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the last 20 yr, the rate of neurosurgical guideline publication has increased. However, despite the higher volume and increasing emphasis on quality there remains no reliable means of measuring the overall impact of clinical practice guidelines (CPGs). OBJECTIVE To utilize citation analysis to evaluate the dispersion of neurosurgical CPGs. METHODS A list of neurosurgical guidelines was compiled by performing electronic searches using the Scopus (Elsevier, Amsterdam, Netherlands) and National Guideline Clearinghouse databases. The Scopus database was queried to obtain current publication and citation data for all included documents and categorized based upon recognized neurosurgical specialties. The h-index, R-index, h2-index, i10-index, and dissemination index (D-Index) were manually calculated for each subspecialty. RESULTS After applying screening criteria the search yielded 372 neurosurgical CPGs, which were included for bibliometric analysis. The overall calculated h-index for neurosurgery was 56. When broken down by subspecialty trauma/critical care had the highest value at 35, followed by spine and peripheral nerve at 30, cerebrovascular at 28, tumor at 16, pediatrics at 14, miscellaneous at 11, and functional/stereotactic/pain at 6. Cerebrovascular neurosurgery was noted to have the highest D-Index at 3.4. CONCLUSION A comprehensive framework is useful for guideline impact analysis. Bibliometric data provides a novel and adequate means of evaluating the successful dissemination of neurosurgical guidelines. There remains a paucity of data regarding implementation and clinical outcomes of individual guidelines.
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Affiliation(s)
- Jacob R Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Beverly C Walters
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Zileli M, Fornari M, Costa F. Lumbar Spinal Stenosis Recommendations of World Federation of Neurosurgical Societies Spine Committee. World Neurosurg X 2020; 7:100080. [PMID: 32613193 PMCID: PMC7322793 DOI: 10.1016/j.wnsx.2020.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ji-Jun H, Hui-Hui S, Qing L, Heng-Zhu Z. Efficacy of Using Platelet-Rich Plasma in Spinal Fusion Surgery-A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Compliant Meta-Analysis. World Neurosurg 2020; 139:e517-e525. [PMID: 32315791 DOI: 10.1016/j.wneu.2020.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been frequently used to enhance bone regeneration. A meta-analysis was conducted to systematically assess the fusion rate and pain relief of applying PRP during spinal fusion surgery. METHODS Studies investigating spinal fusion surgery combined with PRP were retrieved from Medline and the Web of Science in accordance with the inclusion and exclusion criteria. A quality evaluation was conducted using the Cochrane collaboration tool for randomized controlled trials and the Newcastle-Ottawa scale quality assessment for cohort trials. Statistical analysis was performed using RevMan, version 5.3. RESULTS A total of 12 studies, including 3 randomized controlled trials and 9 cohort studies, with 661 patients, were included in the present meta-analysis. The mean age was 52.3 ± 8.0 years. Overall, the pooled results demonstrated that the differences in the fusion rates between the PRP and non-PRP treatment groups were not statistically significant. The risk ratio was 1.01 (95% confidence interval, 0.95-1.06; P = 0.83). Also, no significant difference in pain relief measured using the visual analog scale was found between the 2 groups. The mean difference was -0.08 (95% confidence interval, -0.26 to 0.11; P = 0.42). CONCLUSIONS Adding PRP did not increase the fusion rates from spinal fusion surgery. In addition, no significant difference was found in pain relief between the PRP and non-PRP treatment groups.
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Affiliation(s)
- Huang Ji-Jun
- Neurosurgery Department, The Second Affiliated Hospital of Soochow University, Suzhou, China; Neurosurgery Department, Northern Jiangsu People's Hospital, Yangzhou City, China
| | - Sun Hui-Hui
- Spine Department, Northern Jiangsu People's Hospital, Yangzhou City, China
| | - Lan Qing
- Neurosurgery Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhang Heng-Zhu
- Neurosurgery Department, The Second Affiliated Hospital of Soochow University, Suzhou, China; Neurosurgery Department, Northern Jiangsu People's Hospital, Yangzhou City, China.
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Yavin D, Casha S, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 80:701-715. [PMID: 28327997 DOI: 10.1093/neuros/nyw162] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/01/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
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Affiliation(s)
- Daniel Yavin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Steven Casha
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Samuel Wiebe
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Thomas E Feasby
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Callie Clark
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Albert Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - R John Hurlbert
- Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Garnette R Sutherland
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
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Abstract
STUDY DESIGN Electronic survey. OBJECTIVE The aim of this study was to identify the international nuances in surgical treatment patterns for severals lumbar degenerative conditions, specifically, to identify differences in responses in each country groupand different treatment trends across countries. SUMMARY OF BACKGROUND DATA Significant variations in treatment of lumbar degenerative conditions exist among spine surgeons, related to the lack of established consensus in the literature. METHODS An online survey with preformulated answers was submitted to 52 orthopedic surgeons, 50 neurosurgeons from four different countries (United States, France, Spain, and Germany) regarding five vignette-cases. Cases included: multilevel stenosis, monolevel stenosis, lytic spondylolisthesis, isthmic lysis, and degenerative scoliosis. The variability for each country was calculated according to the Index of Qualitative Variation (IQV = 0: no variability and 1: maximal variability). We used Fleiss kappa (range: from -1, poor agreement, to 1, almost perfect agreement) for assessing the reliability of agreement between the participants concerning specialties, countries, and age groups. RESULTS For the two stenosis cases, US surgeons were more likely to propose decompression (IQV multilevel = 0.47 and monolevel = 0.32) comparing with European countries more heterogeneous (all IQV >0.70) and more frequently proposing fusion. As regards degenerative scoliosis, all attitudes were extremely heterogeneous with IQV >0.8. Fusion for isthmic spondylolisthesis was more consensual (all IQV <0.63), but attitudes were more heterogeneous for isthmic lysis (IQV ranged from 0.48 to 0.76) with anterior approach proposed in France (37%) and United States (19.2%).The overall interrater agreement was equally slight not only for neurosurgeons (Fleiss Kappa = 0.04) and orthopedic surgeons (Kappa = 0.13), but also for countries (Kappa <0.13) and age groups (Kappa <0.1). CONCLUSION In this study, we found substantial agreement for some spinal conditions but a high variability in some others: intranational and international variations were observed, reflecting the lack of literature consensus. LEVEL OF EVIDENCE 2.
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Nonfusion Does Not Prevent Adjacent Segment Disease: Dynesys Long-term Outcomes With Minimum Five-year Follow-up. Spine (Phila Pa 1976) 2016; 41:265-73. [PMID: 26335675 DOI: 10.1097/brs.0000000000001158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series. OBJECTIVE The aim of this study was to determine the relationship between fusion and adjacent segment disease via Dynesys long-term outcomes. SUMMARY OF BACKGROUND DATA Dynesys is a dynamic stabilization system meant to improve symptoms by stabilizing the spine without fusion and avoiding the development of adjacent segment disease. However, few studies have evaluated long-term outcomes. METHODS All patients were operated on with Dynesys from 2006 to 2009 by a single surgeon at a single institution. We prospectively collected 18 variables among the following categories: patient characteristics, comorbidities, surgical indications, and OR variables. We analyzed two primary endpoints: solid fusion on X-ray and clinical adjacent segment disease (ASD) both at 5 years. Secondary endpoints were time to fusion, time to ASD, reoperation, Oswestry disability index (ODI), and visual analogue scale (VAS) leg pain. We conducted a multivariate analysis via the random forest method. Mann-Whitney U test and Fisher exact test were then used to qualify relationship between variables. RESULTS We had 52 patients to review in the database. Eight had preexisting ASD. Mean follow-up was 92 months (median 87 months). Fifteen had ASD (29%) during follow-up at a mean 45 months (Median 35 months). Nine had a solid fusion (17%), 2 of which also had ASD. Mean time to fusion was 65 months (median 71 months). Differences in improvement of ODI (P = 0.005) and VAS leg pain (P = 0.002) were significant favoring patients without ASD. The multivariate analysis revealed four variables associated with ASD: prior ASD (OR 11.3, P = 0.005), neurological deficit (OR 8.5, P = 0.018), revision OR (OR 8.5, P = 0.018), and multilevel degeneration (OR 0.184, P = 0.026). No variable was associated with fusion. CONCLUSION Dynesys was associated with a high rate of ASD over long-term follow-up despite maintaining a low fusion rate. Prior ASD was the strongest predictor of progressive ASD. LEVEL OF EVIDENCE 3.
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Clinical outcome in lumbar decompression surgery for spinal canal stenosis in the aged population: a prospective Swiss multicenter cohort study. Spine (Phila Pa 1976) 2015; 40:415-22. [PMID: 25774464 DOI: 10.1097/brs.0000000000000765] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. OBJECTIVES To examine whether outcome and quality of life might improve after decompression surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. SUMMARY AND BACKGROUND DATA Lumbar decompression surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. METHODS Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. RESULTS Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. CONCLUSION Patients 80 years or older can expect a clinically meaningful improvement after lumbar decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. LEVEL OF EVIDENCE 3.
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