1
|
Li X, Chen J, Wang B, Liu X, Jiang S, Li Z, Li W, Li Z, Wei F. Evaluating the Status and Promising Potential of Robotic Spinal Surgery Systems. Orthop Surg 2024. [PMID: 39300748 DOI: 10.1111/os.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/22/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024] Open
Abstract
The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low-radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery.
Collapse
Affiliation(s)
- Xiang Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jiasheng Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ben Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zihe Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| |
Collapse
|
2
|
Daher M, Liu J, Baroudi M, Alsoof D, Balmaceno-Criss M, Diebo BG, Antoci V, Daniels AH. Patient-reported Physical and Mental Health Outcomes Following Lumbar Spinal Fusion versus Total Hip and Total Knee Replacement. World Neurosurg 2024:S1878-8750(24)01475-X. [PMID: 39186976 DOI: 10.1016/j.wneu.2024.08.106] [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: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Total hip and knee arthroplasty (THA/TKA) are reliable surgical procedures for alleviating pain and optimizing function. Spinal fusion has also been shown to be beneficial, however the comparative benefit of THA/TKA to lumbar spinal fusion is incompletely understood. METHODS This study analyzed a single-center database of patients who underwent primary lumbar spinal fusion, elective primary TKA, or THA. Patient-reported outcome measures (PROMs) included Veterans-Rand (VR12) Physical and Mental Component Score (PCS/MCS) for TKA/THA and PROMIS (Patient-Reported Outcomes Measurement Information System) Global Mental and Physical Health (GPH/GMH) for spinal fusion. RESULTS A total of 356 patients who underwent TKA, 290 who underwent THA, and 125 who underwent spinal fusion were included. Joint replacement patients were older, with higher body mass index in the TKA group. Spine patients had a lower improvement in physical health than the joint patients (TKA: 9.4 ± 11.2, THA: 15.2 ± 11.2, Spine: 6.2 ± 8.7, P < 0.001) and a lower proportion of patients reaching the minimal clinically important difference (MCID). Spine patients had higher GMH improvements compared with TKA patients (TKA: -1.1 ± 10.7, THA: 1.1 ± 11.9, Spine: 1.8 ± 8.4, P = 0.009) and the highest proportion of patients reaching the MCID. CONCLUSIONS Spinal fusion, total knee arthroplasty, and total hip arthroplasty all significantly improved PROMs at 1-year follow-up. At baseline, spinal fusion patients had better physical function scores and worse mental health scores compared with joint arthroplasty patients, while spinal fusion resulted in mean smaller gains in patient reported physical function and higher gains in patient reported mental health function compared with arthroplasty.
Collapse
Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jonathan Liu
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Makeen Baroudi
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| |
Collapse
|
3
|
Tarazi JM, Koutsogiannis P, Humphrey EK, Khan NZ, Katsigiorgis M, Katsigiorgis G, Cohn RM. Risk Factors for Unexpected Admission Following Lumbar Spine Laminectomy: A National Database Study. Cureus 2024; 16:e55507. [PMID: 38571866 PMCID: PMC10990575 DOI: 10.7759/cureus.55507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Laminectomy is one of the most common orthopedic spine surgeries performed in the United States. Compared to other spine operations such as fusions, laminectomies in isolation are of lower morbidity. However, complications may arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission following a laminectomy. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent a laminectomy procedure from 2015 to 2019 using CPT code 63030. This query yielded 61,708 cases. Demographic, lifestyle, comorbidity, and peri-operative factors were recorded. Independent samples Student's t-tests, chi-squared, and, where appropriate, Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following a laminectomy procedure. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. Results Of the 61,708 patients included in our sample, 2,359 were readmitted within 30 days of surgery, corresponding to a readmission rate of 3.82%. Results of the univariate analysis revealed statistically significant relationships between readmission status and the following patient variables: patient age, sex, BMI, ASA classification, race, bleeding disorder, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, congestive heart failure (CHF), chronic steroid use, total operative time, and tobacco use (p < 0.05). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age greater than 65 (p < 0.05), female sex (p = 0.013), bleeding disorder (p = 0.011), diabetes (p = 0.006), current smoker (p = 0.010), COPD (p < 0.001), steroid use (p = 0.006), ASA Class II or above (p < 0.05), and total operative time (p < 0.001). Conclusion Unplanned 30-day readmission after laminectomy is infrequent. However, increasing age, female sex, steroid use, current smokers, bleeding disorders, diabetes, COPD, CHF, a higher ASA classification, and longer operative times are independent risk factors for readmission following laminectomy.
Collapse
Affiliation(s)
- John M Tarazi
- Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - Petros Koutsogiannis
- Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - Emma K Humphrey
- Department of Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, USA
| | - Nabil Z Khan
- Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - Michael Katsigiorgis
- Department of Orthopedic Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Gus Katsigiorgis
- Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
- Department of Orthopedic Surgery, Northwell Health-Long Island Jewish Valley Stream, Valley Stream, USA
| | - Randy M Cohn
- Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
- Department of Orthopedic Surgery, Northwell Health-Long Island Jewish Valley Stream, Valley Stream, USA
| |
Collapse
|
4
|
Konovalov NA, Brinyuk ES, Poluektov YM, Kaprovoy SV, Onoprienko RA, Zakirov BA, Kim DS, Beloborodov VA, Stepanov IA, Bychkovskii NI. [Long-term postoperative outcomes in patients with lumbosacral spine synovial cysts]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:38-45. [PMID: 39422682 DOI: 10.17116/neiro20248805138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Searching of literature data revealed only a few reports devoted to long-term postoperative outcomes in patients with lumbosacral spine synovial cysts. These results are ambiguous and largely contradictory. OBJECTIVE To analyze the long-term postoperative outcomes in patients with lumbosacral spine synovial cysts. MATERIAL AND METHODS A retrospective observational cohort study was performed between January 2015 ando September 2022. The study included patients who underwent surgical treatment for lumbosacral spine synovial cysts with clinical and neurological manifestations. There were 94 medical records of respondents (36 (38.3%) men and 58 (61.7%) women aged 18-82 years). Mean postoperative follow-up period was 24.6±7.5 months. RESULTS Patients underwent various surgical interventions for synovial cysts. VAS scores of pain syndrome after 3, 6, 9, 12 and 24 postoperative months revealed significant pain relief in the lower back and extremities (p<0.01). In long-term follow-up period, we observed significantly lower disability (Oswestry Disability Index) (p<0.001). Adverse postoperative events occurred in 9 (9.6%) cases. CONCLUSION Interlaminectomy with cyst wall resection and preservation or partial resection (no more than 1/3) of facet joint without segmental fusion is an effective and preferable surgical method with minimal incidence of adverse clinical events.
Collapse
Affiliation(s)
| | - E S Brinyuk
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - B A Zakirov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D S Kim
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia
| | - N I Bychkovskii
- Burdenko Neurosurgical Center, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
5
|
Hou Y, Shi H, Shi H, Zhao T, Shi J, Shi G. A meta-analysis of risk factors for cage migration after lumbar fusion surgery. World Neurosurg X 2023; 18:100152. [PMID: 36785623 PMCID: PMC9918778 DOI: 10.1016/j.wnsx.2023.100152] [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: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Objective Cage migration is a rare complication after lumbar fusion surgery, and it is also the cause of lumbar revision surgery. Previous studies have reported that many influencing factors can increase the incidence of cage migration. However, there still remains controversial. The current study was conducted to investigate the risk factors influencing incidence of cage migration. Methods A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until July 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 16.0 software. Results A total of 2126 relevant articles were initially identified, and 7 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the bony endplate injury, pear-shaped disc, and screw loosening are significantly correlated with cage migration. The OR values (95%CI) of the three factors were 7.170 (3.015, 17.051), 8.056 (4.050, 16.023), and 12.840 (3.570, 46.177) respectively. Conclusion Bony endplate injury, pear-shaped disc, and screw loosening are the current risk factors for cage migration postoperatively.
Collapse
|
6
|
Francis JJ, Goacher E, Fuge J, Hanrahan JG, Zhang J, Davies B, Trivedi R, Laing R, Mannion R. Lumbar decompression surgery for cauda equina syndrome - comparison of complication rates between daytime and overnight operating. Acta Neurochir (Wien) 2022; 164:1203-1208. [PMID: 35237869 DOI: 10.1007/s00701-022-05173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the incidence of complications from lumbar decompression ± discectomy surgery for cauda equina syndrome (CES), assessing whether time of day is associated with a change in the incidence of complications. METHODS Electronic clinical and operative notes for all lumbar decompression operations undertaken at our institution for CES over a 2-year time period were retrospectively reviewed. "Overnight" surgery was defined as any surgery occurring between 18:00 and 08:00 on any day. Clinicopathological characteristics, surgical technique, and peri/post-operative complications were recorded. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. RESULTS A total of 81 lumbar decompression operations were performed in the 2-year period and analysed. A total of 29 (36%) operations occurred overnight. Complete CES (CESR) was seen in 13 cases (16%) in total, 7 of whom underwent surgery during the day. Exactly 27 complications occurred in 24 (30%) patients. The most frequently occurring complication was a dural tear (n = 21, 26%), followed by post-operative haematoma, infection, and residual disc. Complication rates in the CESR cohort (54%) were significantly greater than in the CES incomplete (CESI) cohort (25%) (p = 0.04). On multivariable analysis, overnight surgery was independently associated with a significantly increased complication rate (OR 2.83, CI 1.02-7.89). CONCLUSIONS Lumbar decompressions performed overnight for CES were more than twice as likely to suffer a complication, in comparison to those performed within daytime hours. Our study suggests that out-of-hours operating, particularly at night, must be clinically justified and should not be influenced by day-time operating capacity.
Collapse
Affiliation(s)
- Jibin J Francis
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK.
| | - Edward Goacher
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Joshua Fuge
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John G Hanrahan
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin Davies
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Rodney Laing
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Richard Mannion
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| |
Collapse
|
7
|
Goacher E, Sanders MI, Ivanov M. Safety and feasibility of same-day discharge following lumbar decompression surgery: A systematic review. BRAIN & SPINE 2022; 2:100888. [PMID: 36248095 PMCID: PMC9559968 DOI: 10.1016/j.bas.2022.100888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
Introduction Lumbar decompression (LD) surgery, with or without discectomy, is a commonly performed surgical procedure. Despite the concept of day-case LD being reported as early as the 1980s, day-case LD is yet to become routine clinical practice. Research question This systematic review aimed to examine the published literature on the safety and complication rates of day-case LD. Secondary outcome measures, including the economic impact and patient satisfaction of day-case LD, were also examined. Materials and methods A systematic electronic search was carried out on PubMed, EMBASE and the Cochrane Library between 1999 and January 2022. Studies were screened against predefined inclusion/exclusion criteria with the quality of included studies subsequently being assessed. Results In total, 15 studies were included in this review. The majority of studies were undertaken in the USA (n = 8, 53%) and were of a case series design (n = 9, 60%). Reported complication rates ranged from 0% to 7.8%, with nine studies reporting a complication rate of <4%. Readmission rates ranged from 0% to 7.7%. Seven studies quoted a readmission rate of 0%. Five studies found cost saving benefits of day-case LD in comparison to inpatient LD of up to $27,984 (USD). Patient acceptability of day-case LD was consistently high across the six studies that assessed it. Discussion and conclusion Day-case LD surgery is a safe and economically efficient surgical option in appropriately selected patients.
Collapse
Affiliation(s)
- Edward Goacher
- Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Matthew I. Sanders
- Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Marcel Ivanov
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| |
Collapse
|
8
|
Good CR, Orosz L, Schroerlucke SR, Cannestra A, Lim JY, Hsu VW, Zahrawi F, Villalobos HJ, Ramirez PM, Sweeney T, Wang MY. Complications and Revision Rates in Minimally Invasive Robotic-Guided Versus Fluoroscopic-Guided Spinal Fusions: The MIS ReFRESH Prospective Comparative Study. Spine (Phila Pa 1976) 2021; 46:1661-1668. [PMID: 33826591 PMCID: PMC8565511 DOI: 10.1097/brs.0000000000004048] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, multicenter, partially randomized. OBJECTIVE Assess rates of complications, revision surgery, and radiation between Mazor robotic-guidance (RG) and fluoro-guidance (FG). SUMMARY OF BACKGROUND DATA Minimally invasive surgery MIS ReFRESH is the first study designed to compare RG and FG techniques in adult minimally invasive surgery (MIS) lumbar fusions. METHODS Primary endpoints were analyzed at 1 year follow-up. Analysis of variables through Cox logistic regression and a Kaplan-Meier Survival Curve of surgical complications. RESULTS Nine sites enrolled 485 patients: 374 (RG arm) and 111 (FG arm). 93.2% of patients had more than 1 year f/u. There were no differences for sex, Charlson Comorbidity Index, diabetes, or tumor. Mean age of RG patients was 59.0 versus 62.5 for FG (P = 0.009) and body mass index (BMI) was 31.2 versus 28.1 (P< 0.001). Percentage of smokers was almost double in the RG (15.2% vs. 7.2%, P = 0.029). Surgical time was similar (skin-to-skin time/no. of screws) at 24.9 minutes RG and 22.9 FG (P = 0.550). Fluoroscopy during surgery/no. of screws was 15.5 seconds RG versus 35.4 seconds FG, (15 seconds average reduction). Fluoroscopy time during instrumentation/no. of screws was 3.6 seconds RG versus 17.8 seconds FG showing an 80% average reduction of fluoro time/screw in RG (P < 0.001). Within 1 year follow-up, there were 39 (10.4%) surgical complications RG versus 39 (35.1%) FG, and 8 (2.1%) revisions RG versus 7 (6.3%) FG. Cox regression analysis including age, sex, BMI, CCI, and no. of screws, demonstrated that the hazard ratio (HR) for complication was 5.8 times higher FG versus RG (95% CI: 3.5-9.6, P < 0.001). HR for revision surgery was 11.0 times higher FG versus RG cases (95% CI 2.9-41.2, P < 0.001). CONCLUSION Mazor robotic-guidance was found to have a 5.8 times lower risk of a surgical complication and 11.0 times lower risk for revision surgery. Surgical time was similar between groups and robotic-guidance reduced fluoro time per screw by 80% (approximately 1 min/case).Level of Evidence: 2.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Faissal Zahrawi
- Department of Orthopedic Surgery, Florida Hospital, Celebration, FL
| | | | | | - Thomas Sweeney
- Southeastern Spine Center & Research Institute, Sarasota, FL
| | - Michael Y. Wang
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL
| |
Collapse
|
9
|
Khanna R, Malone H, Keppetipola KM, Deutsch H, Fessler RG, Fontes RB, O'Toole JE. Multilevel Minimally Invasive Lumbar Decompression: Clinical Efficacy and Durability to 2 Years. Int J Spine Surg 2021; 15:795-802. [PMID: 34281953 PMCID: PMC8375705 DOI: 10.14444/8102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The clinical efficacy of single-level minimally invasive lumbar decompression and/or microdiscectomy is well established, with improved postoperative functional outcome and pain scores. However, there is a paucity of clinical data supporting the use of minimally invasive (MIS) techniques in a single operation to address pathology at multiple lumbar levels, and this study attempts to address this issue. METHODS A retrospective review of prospectively collected data from patients with symptomatic lumbar stenosis and/or disc herniations who underwent multilevel minimally invasive decompression or microdiscectomy from November 2014 to February 2018 was conducted at a single academic medical center. Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back and leg pain, 12-Item Short Form Health Survey (SF-12) Physical Component Summary Score (PCS) and Mental Component Summary Score (MCS), and Scoliosis Research Society survey (SRS-30), were prospectively collected before surgery and at 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS During the study period, 92 patients received multilevel (≥2 level) MIS lumbar decompression and/or discectomy (69 two level, 21 three level, 2 four level). The mean age at surgery was 69.7 years, and 23 (25%) patients were women. Patient-reported outcomes were significantly improved both in the short and long term except for the SF-12 MCS. Average improvement from baseline was (at 3 months and 2 years, respectively): VAS back, -3.9 and -2.8; VAS leg, -3.6 and -2.6; ODI, -13 and -14.6; SF-12 MCS, 2.8 and -0.3; SF-12 PCS, 6.9 and 10.1; and SRS-30, 0.57 and 0.55. Minimal clinically important difference for the study population was reached for every PROM except SF-12 MCS. Surgical complications occurred in 16 patients (17.4%), and 8 patients (8.6%) required postoperative fusions within 2 years. CONCLUSION The use of MIS techniques to perform lumbar decompression and/or discectomy at multiple levels was found to be both clinically effective and durable. Fusion rates remained low 2 years after the index surgery and were consistent with literature data for open procedures. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Hani Malone
- Department of Neurosurgery, Scripps Clinic, La Jolla, California
| | | | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ricardo B. Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - John E. O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
10
|
Yeo JB, Lee E, Lee JW, Kim BR, Kang Y, Ahn JM, Park SM, Kang HS. Immediate postoperative MRI findings after lumbar decompression surgery: Correlation of imaging features with clinical outcome. J Clin Neurosci 2021; 89:365-374. [PMID: 34088576 DOI: 10.1016/j.jocn.2021.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/25/2020] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. We retrospectively analyzed the immediate postoperative MRIs of 121 consecutive patients who underwent lumbar decompression surgery between July 2017 and June 2018. Changes in stenosis at the decompressed and adjacent levels, epidural fat edema, epidural and subdural fluid collections, nerve root swelling, facet joint effusions, intervertebral disc signal, and paravertebral muscle edema were correlated with clinical characteristics. Both groups had reduced central canal stenosis postoperatively (p < 0.001) but worsened stenosis at adjacent segments. Fluid collection, hemorrhagic or non-hemorrhagic, at the laminectomy site was the commonest finding (one-level: 73.8%, two-level: 88.5%), with a higher percentage of severe central canal compromise in the two-level decompression group (p = 0.003). Other postoperative MRI findings, such as epidural fat edema, nerve root swelling, subdural fluid collection, and facet joint effusion, were noted without statistical significance. In conclusion, even with successful decompression for lumbar canal stenosis, increased central canal stenosis at adjacent segments is common on immediate postoperative MRI scans, showing no statistically significant correlation with the immediate postoperative outcome. Postoperative fluid collection at the laminectomy site is the commonest imaging finding, and higher rates of hemorrhagic fluid and more severe central canal compromise occur in two-level decompression, but rarely cause clinical problems.
Collapse
Affiliation(s)
- Joon Bum Yeo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Bo Ram Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| |
Collapse
|
11
|
Kim SK, Park SW, Lim BC, Lee SC. Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases. J Neurol Surg A Cent Eur Neurosurg 2020; 81:392-398. [PMID: 32361983 DOI: 10.1055/s-0040-1709164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND STUDY AIM Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. PATIENTS AND METHODS This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. RESULTS Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. CONCLUSION The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.
Collapse
Affiliation(s)
- Seung-Kook Kim
- Himchan UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah, United Arab Emirates.,Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon, Korea.,Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Seoung-Woo Park
- Department of Neurosurgery, College of Medicine, Graduate School, Kangwon National University, Chuncheon, Korea
| | - Byun-Chul Lim
- Department of Neurosurgery, College of Medicine, Graduate School, Kangwon National University, Chuncheon, Korea
| | - Su-Chan Lee
- Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| |
Collapse
|
12
|
Bhaskar S, Gosal JS, Garg M, Jha DK. Letter to the editor regarding "why would two patients with no disease be offered unnecessary transforaminal lumbar interbody fusions?". Surg Neurol Int 2019; 10:238. [PMID: 31893139 PMCID: PMC6911681 DOI: 10.25259/sni_553_2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
13
|
Ausman JI. The AANS suspends Editor-in-Chief, Nancy Epstein, for telling the truth about spine surgery. Surg Neurol Int 2019; 10:144. [PMID: 31528479 PMCID: PMC6744753 DOI: 10.25259/sni_365_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- James I Ausman
- Department of Neurosurgery, UCLA School of Medicine, Los Angeles, CA, United States
| |
Collapse
|
14
|
Epstein NE. "Evidence of Overuse of Medical Services Around the World" By Brownlee et al., Lancet, 2017: Does This Apply to Transforaminal Lumbar Interbody Fusions (TLIF)? Surg Neurol Int 2019; 10:154. [PMID: 31528489 PMCID: PMC6744801 DOI: 10.25259/sni_386_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 01/25/2023] Open
Affiliation(s)
- Nancy E Epstein
- Professor of Clinical Neurosurgery, School of Medicine, State University of New York at Stony Brook, New York, and Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop NeuroScience/Neurosurgery, Mineola, New York 11501, United States
| |
Collapse
|
15
|
Epstein NE. Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery. Surg Neurol Int 2018; 9:251. [PMID: 30637169 PMCID: PMC6302553 DOI: 10.4103/sni.sni_372_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.
Collapse
Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurological Surgery, School of Medicine, State University of N.Y. at Stony Brook, and Chief of Neurosurgical Spine/Education at NYU Winthrop Hospital, Mineola, NY 11501, USA
| |
Collapse
|