1
|
Meade M, Issa TZ, Lee Y, Lambrechts MJ, Charlton A, Radack T, Kalra A, Mangan J, Canseco JA, Kurd MF, Woods BI, Kaye ID, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The Impact of Unexpected Billing in Spine Surgery and How the Price Calculator Can Improve Patient Care. Clin Spine Surg 2023; 36:E499-E505. [PMID: 37651568 DOI: 10.1097/bsd.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Survey study. OBJECTIVE The objective of this study was to determine the impact of unexpected in-network billing on the patient experience after spinal surgery. SUMMARY OF BACKGROUND DATA The average American household faces difficulty paying unexpected medical bills. Although legislative efforts have targeted price transparency and rising costs, elective surgical costs continue to rise significantly. Patients are therefore sometimes still responsible for unexpected medical costs, the impact of which is unknown in spine surgery. METHODS Patients who underwent elective spine surgery patients from January 2021 to January 2022 at a single institution were surveyed regarding their experience with the billing process. Demographic characteristics associated with unexpected billing situations, patient satisfaction, and financial distress, along with utilization and evaluation of the online price estimator, were collected. RESULTS Of 818 survey participants, 183 (22.4%) received an unexpected in-network bill, and these patients were younger (56.7 vs. 63.4 y, P <0.001). Patients who received an unexpected bill were more likely to feel uninformed about billing (41.2% vs. 21.7%, P <0.001) and to report that billing impacted surgical satisfaction (53.8% vs. 19.1%, P <0.001). However, both groups reported similar satisfaction postoperatively (Likert >3/5: 86.0% vs. 85.5%, P =0.856). Only 35 (4.3%) patients knew of the price estimator's existence. The price estimator was reported to be very easy or easy (N=18, 78.2%) to understand and very accurate (N=6, 35.3%) or somewhat accurate (N=8, 47.1%) in predicting costs. CONCLUSIONS Despite new regulations, a significant portion of patients received unexpected bills leading to financial distress and affecting their surgical experience. Although most patients were unaware of the price estimator, almost all patients who did know of it found it to be easy to use and accurate in cost prediction. Patients may benefit from targeted education efforts, including information on the price estimator to alleviate unexpected financial burden.
Collapse
Affiliation(s)
- Matthew Meade
- Department of Orthopaedic Surgery, Jefferson Washington Township Hospital, Sewell, NJ
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Alexander Charlton
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tyler Radack
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Andrew Kalra
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - John Mangan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
2
|
Zhu MT, Hu BS, Chen CM, Liu HQ, Lin GX. Comparison of Full Endoscopic Lumbar Diskectomy Using the Transforaminal Approach versus Interlaminar Approach for L5-S1 Lumbar Disk Herniation Treatment: A Meta-Analysis. J Neurol Surg A Cent Eur Neurosurg 2023. [PMID: 36918155 DOI: 10.1055/a-2053-8365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Numerous studies have examined the clinical effectiveness of transforaminal full endoscopic lumbar diskectomy (T-FELD) and interlaminar full endoscopic lumbar diskectomy (I-FELD) for L5-S1 lumbar disk herniation (LDH), with mixed findings. The goal of this systematic review and meta-analysis was to evaluate the perioperative outcomes, clinical results, and complications of T-FELD and I-FELD to determine their efficacy and safety for treating L5-S1 LDH and to examine the features of complications in depth. METHODS Several databases were searched for articles that matched all of the inclusion criteria. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to assess the clinical results. Information on perioperative outcomes and complications was gathered and analyzed. RESULTS Eight studies with 756 participants were included. There were no significant differences in postoperative bed time (p = 0.44) and hospitalization time (p = 0.49) between T-FELD and I-FELD. When compared with I-FELD, T-FELD was associated with substantially longer fluoroscopy time (p < 0.0001) and operating time (p < 0.0001). There were no significant differences in the preoperative and postoperative VAS and ODI scores between T-FELD and I-FELD. The rates for overall complications, postoperative dysesthesia, postoperative lower extremity pain, incomplete decompression, recurrence, and conversion to open surgery were comparable for T-FLED and I-FELD. CONCLUSION T-FELD and I-FELD had equal clinical results and safety for treatment of L5-S1 LDH. Fluoroscopy and operative times were shorter for I-FELD than for T-FELD.
Collapse
Affiliation(s)
- Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
| | - Hong-Qi Liu
- Department of Orthopedics, Zhangpu Country Hospital, Zhangzhou, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| |
Collapse
|
3
|
Smeele NVR, Chorus CG, Schermer MHN, de Bekker-Grob EW. Towards machine learning for moral choice analysis in health economics: A literature review and research agenda. Soc Sci Med 2023; 326:115910. [PMID: 37121066 DOI: 10.1016/j.socscimed.2023.115910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Discrete choice models (DCMs) for moral choice analysis will likely lead to erroneous model outcomes and misguided policy recommendations, as only some characteristics of moral decision-making are considered. Machine learning (ML) is recently gaining interest in the field of discrete choice modelling. This paper explores the potential of combining DCMs and ML to study moral decision-making more accurately and better inform policy decisions in healthcare. METHODS An interdisciplinary literature search across four databases - PubMed, Scopus, Web of Science, and Arxiv - was conducted to gather papers. Based on the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) guideline, studies were screened for eligibility on inclusion criteria and extracted attributes from eligible papers. Of the 6285 articles, we included 277 studies. RESULTS DCMs have shortcomings in studying moral decision-making. Whilst the DCMs' mathematical elegance and behavioural appeal hold clear interpretations, the models do not account for the 'moral' cost and benefit in an individual's utility calculation. The literature showed that ML obtains higher predictive power, model flexibility, and ability to handle large and unstructured datasets. Combining the strengths of ML methods with DCMs has the potential for studying moral decision-making. CONCLUSIONS By providing a research agenda, this paper highlights that ML has clear potential to i) find and deepen the utility specification of DCMs, and ii) enrich the insights extracted from DCMs by considering the intrapersonal determinants of moral decision-making.
Collapse
Affiliation(s)
- Nicholas V R Smeele
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Caspar G Chorus
- Department of Engineering Systems and Services, Delft University of Technology, Delft, the Netherlands; Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Oshita Y, Matsuyama D, Sakai D, Schol J, Shirasawa E, Emori H, Segami K, Takahashi S, Yagura K, Miyagi M, Saito W, Imura T, Nakazawa T, Inoue G, Hiyama A, Katoh H, Akazawa T, Kanzaki K, Sato M, Takaso M, Watanabe M. Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091284. [PMID: 36143959 PMCID: PMC9501482 DOI: 10.3390/medicina58091284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.
Collapse
Affiliation(s)
- Yusuke Oshita
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Kanagawa, Japan
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
| | - Daisuke Matsuyama
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Hatano Red Cross Hospital, Hatano 257-0017, Kanagawa, Japan
| | - Daisuke Sakai
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
- Correspondence: ; Tel.: +81-46-393-1121
| | - Jordy Schol
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Haruka Emori
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Kanagawa, Japan
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
| | - Kazuyuki Segami
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, 227-8501, Kanagawa, Japan
| | - Shu Takahashi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, 227-8501, Kanagawa, Japan
| | - Kazumichi Yagura
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, 227-8501, Kanagawa, Japan
| | - Masayuki Miyagi
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Wataru Saito
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Takayuki Imura
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Toshiyuki Nakazawa
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Gen Inoue
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Akihiko Hiyama
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Hiroyuki Katoh
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Tsutomu Akazawa
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Kanagawa, Japan
| | - Koji Kanzaki
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, 227-8501, Kanagawa, Japan
| | - Masato Sato
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Masashi Takaso
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Masahiko Watanabe
- Nonprofit Organization, Kanagawa Spine Research Society, Isehara 259-1193, Kanagawa, Japan
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| |
Collapse
|
5
|
Comparison of Needle-Warming Moxibustion and Other Physical Therapies for Lumbar Disc Herniation: A Meta-analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2986223. [PMID: 35936359 PMCID: PMC9352493 DOI: 10.1155/2022/2986223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022]
Abstract
Background. Needle-warming moxibustion (NWM) demonstrates a controversial effect on lumbar disc herniation (LDH). This study is aimed at comparing the efficacy of NWM and conventional acupuncture or other physical therapies on LDH through a meta-analysis. Methods. Potentially eligible literatures were retrieved and screened from electronic databases. The subject of the literature was a comparison of NWM and conventional acupuncture or other physical therapies for LDH. The methodological quality was evaluated by the Jadad scale. The chi-square test was used for the heterogeneity test. Subgroup analysis was used to explore the source of heterogeneity. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used to describe the effect size. The publication bias was evaluated by Egger’s test. Results. The effective rate of NWM in the treatment of LDH was significantly higher than that of conventional acupuncture (
) and lumbar traction (
) There was no significant difference in the effective rate between NWM and electric acupuncture for LDH (
). VAS of LDH patients treated with NWM was lower than conventional acupuncture (
) and lumbar traction (
) but statistically insignificant with electric acupuncture (
). JOA scores of LDH patients treated with NWM were higher than those with conventional acupuncture (
) and lumbar traction (
) but statistically insignificant with electric acupuncture (
). The long-term effective rate of NWM on LDH was higher than that of conventional acupuncture (
). In this study, no heterogeneity (
) and publication bias (
) among the literature were noted. Conclusion. The effect of NWM on LDH was superior to traction therapy and conventional acupuncture therapy, but similar to electric acupuncture for LDH. High-quality randomized controlled trials were still needed to confirm the results.
Collapse
|
6
|
Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5670303. [PMID: 35774300 PMCID: PMC9239808 DOI: 10.1155/2022/5670303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/19/2022]
Abstract
Objective This study is aimed at exploring the clinical effect of mechanical traction on lumbar disc herniation (LDH). Methods Related literatures were retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. Inclusion of literature topic was comparison of mechanical traction and conventional physical therapy for lumbar disc herniation. Jadad scale was used to evaluate the quality of the included RCT studies. The Chi-square test was used for the heterogeneity test, and a random effect model was used with heterogeneity. Subgroup analysis and sensitivity analysis were used to explore the causes of heterogeneity. If there was no heterogeneity, the fixed effect model was used, and funnel plots were used to test publication bias. Results Visual analog scale (VAS) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −1.39 (95% CI (-1.81, -0.98)), Z = 6.56, and P < 0.00001). There was no heterogeneity among studies (Chi2 = 6.62, P = 0.25, and I2 = 24%) and no publication bias. Oswestry disability index (ODI) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −6.34 (95% CI (-10.28, -2.39)), Z = 3.15, and P = 0.002). There was no heterogeneity between studies (Chi2 = 6.27, P = 0.18, and I2 = 36%) and no publication bias. There was no significant difference in Schober test scores between the mechanical traction group and the conventional physical therapy group (MD = −0.40 (95% CI (-1.07, 0.28)), Z = 1.16, and P = 0.25). There was no heterogeneity among studies (Chi2 = 1.61, P = 0.66, and I2 = 0%) and no publication bias. Conclusion Mechanical traction can effectively relieve lumbar and leg pain and improve ODI in patients with lumbar disc herniation but has no significant effect on spinal motion. The therapeutic effect of mechanical traction was significantly better than that of conventional physical therapy. Lumbar traction can be used in conjunction with other traditional physical therapy.
Collapse
|
7
|
Kerimbayev T, Kenzhegulov Y, Tuigynov Z, Aleinikov V, Urunbayev Y, Makhambetov Y, Pan A, Abishev N, Oshayev M, Baiskhanova D, Solodovnikov M, Akshulakov S. Transforaminal Endoscopic Discectomy Under General and Local Anesthesia: A Single-Center Study. Front Surg 2022; 9:873954. [PMID: 35521432 PMCID: PMC9063724 DOI: 10.3389/fsurg.2022.873954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Percutaneous spinal endoscopy is used for the treatment of disorders of the lumbar spine, as it has several advantages over traditional surgical methods. The performance of percutaneous spinal endoscopy is not possible without applying anesthesia methods. Two types (local and general) of anesthesia are used for percutaneous spinal endoscopy. Both, local and general anesthesia approaches contribute to safety in surgical procedures. Although it is believed that the method of local anesthesia has more benefits over general anesthesia, such as lowering the risk of postoperative neurological complications in a patient, the literature on the topic is inconclusive. The study aims to perform a comparative analysis of the two anesthesia methods using a prospective case-control design. Patients were divided into two groups: those who received local anesthesia (LA) (20 patients), and those who underwent general anesthesia (GA) (20 patients). As a result of the study, 40% of the patients experienced moderate pain and 5% of the patients experienced excruciating pain intraoperatively in the LA group. Although Visual Analog Scale and Oswestry Disability Index scores improved more rapidly in LA group, at the 12-month check-up point there was no significant difference between cases and controls. Nevertheless, there were postoperative complications such as nerve root injury in 10% of the patients; nausea, vomiting, dizziness, drowsiness in 15% of the patients in the GA group, and an insignificant or no such complications in patients of the LA group. The present study demonstrates that LA contributes to more positive short-term outcomes for patients as it facilitates nerve root damage prevention, and has no postoperative side effects on patients' well being.
Collapse
|