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Annapureddy D, Venkatesh P, Azam F, Olivier T, Thakur B, Sloan E, Wingfield S, Bagley C, Lopez M. Predictors of Admission to Post-Acute Rehabilitation Following Multi-Level Spinal Decompression and Fusion Surgery and Its Associated Outcomes. World Neurosurg 2024:S1878-8750(24)00572-2. [PMID: 38599376 DOI: 10.1016/j.wneu.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To investigate predictive factors and outcomes in those admitted to post-acute rehabilitation (PAR) versus those that discharged home following multi-level spinal decompression and fusion surgery. METHODS Retrospective case review study of adults that underwent multi-level spinal decompression and fusion surgery between 2016 and 2022 at an academic institution. Preoperative, perioperative, postoperative, and outcomes variables were compared between those discharged home versus PAR. Finally, multiple logistic regression was used to determine factors contributing to PAR admission. RESULTS Of 241 total patients, 89 (37%) discharged home and 152 (63%) discharged to PAR. Among home discharge patients, 45.9% used an assistive device, while among PAR patients, 61.5% used 1 (P = 0.041). Mean pre-operative Oswestry Disability Index score was significantly lower in the home discharge group compared to the PAR discharge group (40.3 vs. 45.3 respectively, P = 0.044). Females were 2.43 times more likely to be discharged to PAR compared to males (95% CI: 1.06, 5.54, P = 0.04). Patients with a mood disorder had 2.81 times higher odds of being discharged to PAR compared to those without (95% CI: 1.20, 6.60, P = 0.02). Other variables evaluated were not statistically significant. CONCLUSIONS Female sex and presence of a mood disorder increase the likelihood to PAR discharge following multi-level spinal decompression surgery.
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Affiliation(s)
| | - Pooja Venkatesh
- The University of Texas Southwestern Medical School, Dallas, Texas, USA.
| | - Faraaz Azam
- The University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Timothy Olivier
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bhaskar Thakur
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Sloan
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah Wingfield
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, Missouri, USA
| | - Marielisa Lopez
- Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sweetman H, Rahman M, Vedantam A, Satkunendrarajah K. Subclinical respiratory dysfunction and impaired ventilatory adaptation in degenerative cervical myelopathy. Exp Neurol 2024; 371:114600. [PMID: 37907124 DOI: 10.1016/j.expneurol.2023.114600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
Degenerative cervical myelopathy (DCM) is a debilitating neurological condition characterized by chronic compression of the cervical spinal cord leading to impaired upper and lower limb function. Despite damage to areas of the cervical spinal cord that house the respiratory network, respiratory dysfunction is not a common symptom of DCM. However, DCM may be associated with respiratory dysfunction, and this can affect the ventilatory response to respiratory challenges during emergence from anesthesia, exercise, or pulmonary disease. Surgical spinal cord decompression, which is the primary treatment for DCM, leads to improved sensorimotor function in DCM; yet its impact on respiratory function is unknown. Here, using a clinically relevant model of DCM, we evaluate respiratory function during disease progression and assess adaptive ventilation to hypercapnic challenge before and after surgical intervention. We show that despite significant and progressive forelimb and locomotor deficits, there was no significant decline in eupneic ventilation from the early to late phases of spinal cord compression. Additionally, for the first time, we demonstrate that despite normal ventilation under resting conditions, DCM impairs acute adaptive ventilatory ability in response to hypercapnia. Remarkably, akin to DCM patients, surgical decompression treatment improved sensorimotor function in a subset of mice. In contrast, none of the mice that underwent surgical decompression recovered their ability to respond to hypercapnic ventilatory challenge. These findings underscore the impact of chronic spinal cord compression on respiratory function, highlighting the challenges associated with ventilatory response to respiratory challenges in individuals with DCM. This research highlights the impact of cervical spinal cord compression on respiratory dysfunction in DCM, as well as the persistence of adaptive ventilatory dysfunction after surgical spinal cord decompression. These results indicate the need for additional interventions to enhance recovery of respiratory function after surgery for DCM.
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Affiliation(s)
- Hannah Sweetman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Mahmudur Rahman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Kajana Satkunendrarajah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Aimar E, Iess G, Labiad I, Mezza F, Bona A, Ciuffi A, Grassia F, Isidori A, Zekaj E, Bonomo G. Degenerative L4-L5 spondylolisthesis and stenosis surgery: does over-level flavectomy technique influence clinical outcomes and rates of cranial adjacent segment disease? Acta Neurochir (Wien) 2023; 165:3107-3117. [PMID: 37632571 DOI: 10.1007/s00701-023-05761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar fusion associated with total laminectomy at the same level with those undergoing partial laminectomy. No study has examined the role of selective over-level flavectomy (OLF; i.e., L3-L4). METHODS A total of 299 patients undergoing posterolateral arthrodesis (PLA) for L4-L5 degenerative spondylolisthesis were retrospectively analyzed with a 5-year follow-up. 148 patients underwent PLA + L4-L5 flavectomy + L4 partial laminectomy (control group), while 151 underwent PLA + L4-L5 flavectomy + total L4 laminectomy + L3-L4 flavectomy (OLF group). Rates of reoperations due to CASD were examined utilizing Cox proportional hazard models, while clinical improvement at follow-up (measured in ODI) was analyzed using generalized linear models (GLMs). Adjustments for potential confounders were made (grade of lumbar lordosis, age, sex, BMI, intervertebral disc degeneration, and presurgical cranial spinal stenosis). RESULTS At 5 years from the operation, 16 patients (10.8%) in the control group had undergone revision surgery for CASD compared to 5 patients (3.3%) in the OLF group (p = 0.013). Survival analysis and GLM demonstrated that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcome. There were no differences in the rate of discal degeneration or the onset of Meyerding's grade I degenerative spondylolisthesis at the adjacent segment. BMI was the only other significant predictor of ODI improvement and of the incidence of CASD. CONCLUSIONS In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
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Affiliation(s)
- Enrico Aimar
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy.
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy.
- Università degli Studi di Milano, Lumbardy, Milan, Italy.
| | - Ikrame Labiad
- Università degli Studi di Milano, Lumbardy, Milan, Italy
| | - Federica Mezza
- Department of Economics, Bocconi University, Lumbardy, Milan, Italy
| | - Alberto Bona
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Andrea Ciuffi
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Fabio Grassia
- Department of Neurosurgery, Anschutz medical campus, Aurora, CO, USA
| | - Alessandra Isidori
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy
- Università degli Studi di Milano, Lumbardy, Milan, Italy
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舒 涛, 吴 帝, 沈 茂. [Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:895-900. [PMID: 37460188 PMCID: PMC10352501 DOI: 10.7507/1002-1892.202303110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Indexed: 07/20/2023]
Abstract
Objective To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). Methods The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. Results At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. Conclusion The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
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Affiliation(s)
- 涛 舒
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 帝求 吴
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 茂 沈
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
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Patel D, Benjamin J, Patel A, Fleeting C, Casauay J, Foreman M, Sheth S, Lucke-Wold B. Neurostimulation for Spinal Lesions: Enhancing Recovery and Axonal Regeneration. J Med Res Surg 2023; 4:46-57. [PMID: 37384035 PMCID: PMC10306172 DOI: 10.52916/jmrs234107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Spinal neurostimulation is a promising approach for treating spinal lesions and has implications in various neurological disorders. It promotes axonal regeneration and neuronal plasticity to reestablish disrupted signal transduction pathways following spinal injuries or degeneration. This paper reviews the current technology and its differing utilities in various types of neurostimulation, including invasive and noninvasive methods. The paper also explores the efficacy of spinal compression and decompression therapy, with a primary focus on degenerative spinal disorders. Moreover, the potential of spinal neurostimulation in therapies for motor disorders, such as Parkinson's disease and demyelinating disorders, is discussed. Finally, the paper examines the changing guidelines of use for spinal neurostimulation following surgical tumor resection. The review suggests that spinal neurostimulation is a promising therapy for axonal regeneration in spinal lesions. This paper concludes that future research should focus on the long-term effects and safety of these existing technologies, optimizing the use of spinal neurostimulation to enhance recovery and exploring its potential for other neurological disorders.
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Affiliation(s)
- Drashti Patel
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Jonathan Benjamin
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Aashay Patel
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Chance Fleeting
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Jed Casauay
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Marco Foreman
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Sohum Sheth
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- University of Florida, Department of Neurosurgery, Gainesville, Florida, USA
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Blackett J, McClure JA, Kanawati A, Welk B, Vogt K, Vinden C, Rasoulinejad P, Bailey CS. Rates, Predictive Factors, and Adverse Outcomes of Fusion Surgery for Lumbar Degenerative Disorders in Ontario, Canada, Between 2006 and 2015: A Retrospective Cohort Study. World Neurosurg 2022; 168:e196-e205. [PMID: 36150601 DOI: 10.1016/j.wneu.2022.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The addition of fusion surgery to the decompression for lumbar degenerative disorders remains controversial. The purpose of this study is to compare the rate and outcome of decompression and fusion versus decompression alone. METHODS This population-based retrospective cohort study used several linked administrative databases to identify patients who underwent spinal decompression surgery in Ontario, Canada, from 2006 to 2015. Patients who had previous spine surgery, concurrent lumbar disc replacement, or a diagnosis other than degenerative disc disease were excluded. Adjusted logistic regression was used to assess our outcomes. RESULTS We identified 33,912 patients, of whom 9748 (28.74%) underwent fusion. Overall, fusion rates increased from 27.66% to 31.33% over the study period (P = 0.025). Factors associated with fusion included: older age, female sex, American Society of Anesthesiologists score ≥3, previous total joint replacement, and surgery by an orthopedic surgeon. Fusion surgery was associated with increased odds of 30-day mortality (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.01-3.09; P = 0.046), 30-day (OR 1.94, 95% CI 1.53-2.46; P < 0.0001) and 90-day reoperation (OR 1.66, 95% CI 1.35-2.05; P < 0.0001), and 30-day readmission (OR 1.23, 95% CI 1.02-1.49; P = 0.027) when adjusting for confounding variables. The odds of suffering a complication after fusion and decompression surgery vs. decompression surgery alone were 4.3-fold greater (95% CI 3.78-5.09; P < 0.0001). CONCLUSIONS As compared with decompression alone, spinal fusion for degenerative lumbar disorders is associated with increased odds of adverse outcomes. These findings highlight the need for spine surgeons to consider carefully their indications for fusion procedures in the setting of degenerative spinal disorders.
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Affiliation(s)
- James Blackett
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, London Health Science Centre, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Andrew McClure
- Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada
| | - Andrew Kanawati
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, London Health Science Centre, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada
| | - Kelly Vogt
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Chris Vinden
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada
| | - Parham Rasoulinejad
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, London Health Science Centre, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Christopher S Bailey
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, London Health Science Centre, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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Wu PH, Sebastian M, Kim HS, Heng GTY. How I do it? Uniportal full endoscopic pseudoarthrosis release of left L5/S1 Bertolotti's syndrome under intraoperative computer tomographic guidance in an ambulatory setting. Acta Neurochir (Wien) 2021; 163:2789-2795. [PMID: 34420129 DOI: 10.1007/s00701-021-04975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is limited literature on technique full endoscopic pseudoarthrosis release of Bertolotti syndrome. METHODS Uniportal full endoscopic pseudoarthrosis release technique applies for patients presenting with symptomatic Bertolotti's syndrome. Full-thickness endoscopic drilling is carried out from most ventrolateral margin of pseudoarthrosis articulating with the highest part of sacral ala (PH) point to dorsal medioinferior margin of pseudoarthrosis adjacent to superior articular process (MS) point. Complete pseudoarthrosis release was confirmed with an intraoperative 3D imaging system. CONCLUSION The uniportal full endoscopic pseudoarthrosis release is a good alternative to open surgery to release pseudoarthrosis in L5/S1 Bertolotti's syndrome in an ambulatory setting.
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Affiliation(s)
- Pang Hung Wu
- Orthopaedic Surgery, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Matthew Sebastian
- Orthopaedic Surgery, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Hyeun Sung Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, South Korea
| | - Gamaliel Tan Yu Heng
- Orthopaedic Surgery, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore
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Abstract
AIM This project explored how the implementation of national guidance for investigation and management of patients with suspected cauda equina syndrome impacted on service provision. METHODS Retrospective analysis of patients with suspected cauda equina syndrome during 12 months before the implementation of the national guidelines were compared with data from the 21 months following. RESULTS Monthly mean numbers of referrals for suspected cauda equina syndrome increased from 10.1 to 18.9 (P<0.001). Statistically significant increases were also seen in the total number of magnetic resonance imaging scans for suspected cauda equina syndrome, and the number of magnetic resonance imaging scans performed out of hours. The mean time interval, from magnetic resonance imaging scan confirming cauda equina syndrome to starting emergency decompressive surgery, reduced from 14.87 hours to 9.57 hours. CONCLUSIONS Compliance with the national guidance for suspected cauda equina syndrome is imperative for patients to receive optimal treatment. However, this project has demonstrated challenges related to increased pressure on resources.
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Affiliation(s)
- Selina Graham
- Spinal Surgery Service, Department of Orthopaedics and Trauma, Somerset Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK, on behalf of the Cauda Equina Syndrome Study Group (CESSG) at Somerset Foundation Trust Members of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust: Selina Graham, Pradeep Madhavan, Paul Thorpe, Yee Leung, Ashok Subramanian, Dushan Thavarajah, Paul Burn, Danial Fox, Guru Karnati, Iain Palmer on behalf of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust
| | - Pradeep Madhavan
- Spinal Surgery Service, Department of Orthopaedics and Trauma, Somerset Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK, on behalf of the Cauda Equina Syndrome Study Group (CESSG) at Somerset Foundation Trust Members of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust: Selina Graham, Pradeep Madhavan, Paul Thorpe, Yee Leung, Ashok Subramanian, Dushan Thavarajah, Paul Burn, Danial Fox, Guru Karnati, Iain Palmer on behalf of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust
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Seidel H, Bhattacharjee S, Pirkle S, Shi L, Strelzow J, Lee M, El Dafrawy M. Long-term rates of bladder dysfunction after decompression in patients with cauda equina syndrome. Spine J 2021; 21:803-809. [PMID: 33434651 DOI: 10.1016/j.spinee.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/06/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cauda equina syndrome (CES) occurs due to compression of the lumbar and sacral nerve roots and is considered a surgical emergency. Although the condition is relatively rare, the associated morbidity can be devastating to patients. While substantial research has been conducted on the timing of treatment, the literature regarding long-term rates of bladder dysfunction in CES patients is scarce. PURPOSE The aim of this study was to identify long-term rates of bladder dysfunction in CES patients and to compare those rates to non-CES patients who underwent similar spinal decompression. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE The CES cohort was comprised of 2,362 patients who underwent decompression surgery following CES diagnosis with a 5-year follow-up. These patients were matched to 9,448 non-CES control patients who underwent spinal decompression without a diagnosis of CES. OUTCOME MEASURES Diagnosis of bladder dysfunction, surgical procedure to address bladder dysfunction METHODS: Using the national insurance claims database, PearlDiver, CES patients who underwent decompression surgery were identified and 1:4 matched to non-CES patients who underwent similar spinal decompression surgery. The 1-year, 3-year, and 5-year rates of progression to a bladder dysfunction diagnosis and surgical intervention to manage bladder dysfunction were recorded. The CES and non-CES groups were compared with univariate testing, and an analysis of risk factors for bladder dysfunction was performed with multivariate logistic regression analysis. RESULTS A total of 2,362 CES patients who underwent decompression surgery were identified and matched to 9,448 non-CES control patients. After 5 years, CES patients had a 10%-12% increased absolute risk of continued bladder dysfunction and a 0.7%-0.9% increased absolute risk of undergoing a surgical procedure for bladder dysfunction, as compared to matched non-CES patients. Multivariate analysis controlling for age, sex, obesity, tobacco use, and diabetes, identified CES as independently associated with increased 5-year risk for bladder dysfunction diagnosis (odds ratio [OR]: 1.72; 95% confidence interaval [CI] 1.56-1.89; p<.001) and procedure (OR: 1.40; 95% CI 1.07-1.81; p=.012). CONCLUSIONS Understanding the long-term risk for bladder dysfunction in CES patients is important for the future care and counseling of patients. Compared to non-CES patients who underwent similar spinal decompression, CES patients were observed to have a significantly higher long-term likelihood for both bladder dysfunction diagnosis and urologic surgical procedure.
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Affiliation(s)
- Henry Seidel
- Pritzker School of Medicine at The University of Chicago, 924 E. 57th St, Suite 104, Chicago, IL 60637, USA
| | - Sarah Bhattacharjee
- Pritzker School of Medicine at The University of Chicago, 924 E. 57th St, Suite 104, Chicago, IL 60637, USA
| | - Sean Pirkle
- Pritzker School of Medicine at The University of Chicago, 924 E. 57th St, Suite 104, Chicago, IL 60637, USA
| | - Lewis Shi
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA
| | - Jason Strelzow
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA
| | - Michael Lee
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA
| | - Mostafa El Dafrawy
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA.
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Velayudhan D, Bhat SN, Mohanty SP. Infiltrating spinal angiolipoma with paraplegia and hydrocephalus: A rare case report. J Taibah Univ Med Sci 2021; 16:295-299. [PMID: 33897338 PMCID: PMC8046939 DOI: 10.1016/j.jtumed.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 12/05/2022] Open
Abstract
Angiolipoma is a rare subtype of lipoma that contains both mature adipocytes and a rich vascular component. Infiltrating spinal angiolipomas causes surgical challenges with potential on-table injuries to adjacent structures. We present a rare case of infiltrating spinal angiolipoma in a 76-year-old woman who presented with paraplegia and hydrocephalus. At the time of presentation, the patient was bedridden for 3 months due to a complete loss of motor power. Imaging examination revealed a lesion involving the T6 vertebra with compressive myelopathy. The patient underwent spinal decompression and resection of the lesion, which turned out to be an infiltrating angiolipoma by histological examination. This is a unique case because spinal angiolipoma is extremely uncommon and such lesions generally manifest without infiltration. This case report highlights the existence and importance of spinal angiolipoma as a differential diagnosis of chronic backache resulting in neurological deficits and hydrocephalus.
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Affiliation(s)
- Dewaraj Velayudhan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shyamasunder N Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Simanchal P Mohanty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Moorthy V, Wang JX, Tang JH, Oh JYL. Postoperative spinal epidural hematoma following therapeutic anticoagulation: case report and review of literature. J Spine Surg 2020; 6:743-749. [PMID: 33447677 DOI: 10.21037/jss-20-636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While the incidence and risk factors of pulmonary embolism (PE) and deep vein thrombosis (DVT) following spinal surgery have been well studied, the treatment of such thromboembolic disease in patients after spine surgery remains controversial. When initiating therapeutic anticoagulation after spine surgery, clinicians must weigh the catastrophic risk of a PE against the risk of bleeding complications associated with anticoagulation therapy. Here we report the case of a 56-year-old male who presented with symptoms of spinal cord compression secondary to metastatic renal cell carcinoma (RCC). An inferior vena cava (IVC) filter was inserted preoperatively and urgent decompression at the thoraco-lumbar region was performed. Therapeutic clexane was started on postoperative day (POD) 7 and he was discharged. On POD 8, he was readmitted following acute bilateral lower limb paralysis. Magnetic resonance imaging (MRI) revealed a large posterior spinal epidural hematoma with severe compression of the conus at L1 level. Urgent posterior decompression was performed but subsequent recovery was slow and incomplete. His power improved gradually over the right lower limb with attainment of grade 4/5 motor power but still had hemiparesis on his left lower limb upon discharge out of hospital. This case highlights the risk of starting therapeutic anticoagulation following spinal surgery. Prior to starting treatment, the clinician must consider the appropriate dose, timing and alternatives available to avoid unnecessary complications.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Jun Han Tang
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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12
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Knio ZO, Schallmo MS, Hsu W, Corona BT, Lackey JT, Marquez-Lara A, Luo TD, Medda S, Wham BC, O'Gara TJ. Unilateral Laminotomy with Bilateral Decompression: A Case Series Studying One- and Two-Year Outcomes with Predictors of Minimal Clinical Improvement. World Neurosurg 2019; 131:e290-e297. [PMID: 31356984 DOI: 10.1016/j.wneu.2019.07.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis. METHODS A database of 255 patients who underwent microdecompression surgery by a single orthopedic spine surgeon between 2014 and 2018 was queried. Patients who underwent primary single-level ULBD of the lumbar spine were included. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) results were collected preoperatively and at 12 and 24 months postoperatively. Demographic, radiographic, and operative factors were assessed for associations with failure to improve. Clinically important improvement was defined as reaching or surpassing the previously established minimum clinically important difference for ODI (12.8) and not requiring revision. RESULTS A total of 68 patients were included. Compared with preoperative values for back pain, leg pain, and ODI (7.32, 7.53, and 51.22, respectively), there were significant improvements on follow-up at 12 months (2.89, 2.23, and 22.40, respectively; P < 0.001) and 24 months (2.80, 2.11, 20.32, respectively; P < 0.001). Based on the defined criteria, 50 patients showed clinically important improvement after ULBD. Of the 18 patients who failed to improve, 12 required revision. Independent predictors of failure to improve included female sex (adjusted odds ratio, 5.06; 95% confidence interval, 1.49-21.12; P = 0.014) and current smoker status (adjusted odds ratio, 5.39; 95% confidence interval, 1.39-23.97; P = 0.018). CONCLUSIONS ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.
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Affiliation(s)
- Ziyad O Knio
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael S Schallmo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wesley Hsu
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Benjamin T Corona
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Justin T Lackey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tianyi D Luo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Suman Medda
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bradley C Wham
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tadhg J O'Gara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Abstract
Degenerative lumbar spondylolisthesis is a common cause of low back pain, affecting about 11.5% of the United States population. Patients with symptomatic lumbar spondylolisthesis may first be treated with conservative management strategies including, but not limited to, non-narcotic and narcotic pain medications, epidural steroid injections, transforaminal injections, and physical therapy. For well-selected patients who fail conservative management strategies, surgical management is appropriate. This article summarizes the guidelines for the treatment of lumbar spondylolisthesis.
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Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA.
| | - Viraj Sharma
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Leslie C Robinson
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
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14
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Ramey WL, Altafulla J, Yilmaz E, Ishak B, Jack A, Litvack ZN, Oskouian RJ, Tubbs RS, Chapman JR. The ABC's of Spinal Decompression: Pearls and Technical Notes. World Neurosurg 2019; 129:e146-e151. [PMID: 31102772 DOI: 10.1016/j.wneu.2019.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The foundation of spine surgery centers on the proper identification, decompression, and stabilization of bony and neural elements. We describe easily reproducible and reliable methods for optimal decompression and release of neural structures to alleviate symptoms and improve patients' quality of life. METHODS Multiple spinal decompression techniques were described in procedures for which the goal of surgery was decompression alone or decompression and fusion. Eight fundamental techniques were described: inverted U-cut, J-cut, T-cut, L-cut, Z-cut, I-track cuts, C-cut, and O-cut. RESULTS These foundational cuts may be combined, as needed, to develop an individually tailored approach to the patient's pathology. CONCLUSIONS After properly identifying the anatomic structures, each of these techniques provides a consistent, reproducible, and efficient means to decompress the spine under various circumstances. These techniques provide surgical trainees with a framework for approaching surgical decompression.
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Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Juan Altafulla
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Emre Yilmaz
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Basem Ishak
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Andrew Jack
- Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Zachary N Litvack
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Department of Neuroanatomy, Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
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15
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Reid DBC, Haglin JM, Durand WM, Daniels AH. Operative Management of Spinal Infection Among Intravenous Drug Abusers. World Neurosurg 2019; 124:e552-e557. [PMID: 30639488 DOI: 10.1016/j.wneu.2018.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recent population-level increases in intravenous drug abuse (IVDA) may contribute to incidence of spinal infection. The aim of this study was to evaluate national trends of spinal infections and evaluate effect of IVDA on outcomes in operative management of spinal infection. METHODS Using the National (Nationwide) Inpatient Sample database for 2002-2014, all patients undergoing spinal decompression or fusion for treatment of spinal infection were evaluated. Inpatient outcomes included length of stay, total cost, complications, discharge to facility, reoperations, and inpatient mortality. Bivariate and multivariate logistic regression analyses were performed to compare patients with IVDA and patients without IVDA. RESULTS A total of 60,964 patients undergoing surgical management of spinal infection were identified. Number of surgically managed spine infections increased from 2002 to 2014 (P < 0.0001). Proportion of surgically managed spine infections associated with IVDA increased from 3.3% in 2002 to 14.0% in 2014 (P < 0.0001). IVDA was associated with increased hospital length of stay (odds ratio = 1.38; 95% confidence interval, 1.32-1.45; P < 0.0001) and greater total charges (odds ratio = 1.23; 95% confidence interval, 1.17-1.29; P < 0.0001). No other significant differences between groups were noted. CONCLUSIONS From 2002 to 2014 in the United States, the incidence of operatively treated spine infections increased 227.9%, and the proportion of cases associated with IVDA significantly increased. Patients with IVDA had a longer mean length of stay and increased inpatient cost of care but were not at increased risk for complication, reoperation, or mortality. These findings are important for surgeons, internists, hospitals, and insurers to ensure proper resource allocation in treating these at-risk patients.
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Affiliation(s)
- Daniel B C Reid
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Orthopedic Surgery, Spine Division, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jack M Haglin
- Mayo Clinic School of Medicine, Scottsdale, Arizona, USA.
| | - Wesley M Durand
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Orthopedic Surgery, Spine Division, Rhode Island Hospital, Providence, Rhode Island, USA
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16
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Hofmann A, Opitz S, Heyde CE, von der Höh NH. Paget's disease of the lumbar spine: decompressive surgery following 17 years of bisphosphonate treatment. Eur Spine J 2018; 27:3066-3070. [PMID: 30242508 DOI: 10.1007/s00586-018-5751-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We present a rare case of Paget's disease (PD) with involvement of the lumbar spine over a period of 19 years. We discuss the diagnostic process to rule out alternative diagnoses and medical and surgical treatment strategies. CASE DESCRIPTION A 58-year-old man first diagnosed with PD in 1998 with solid involvement of the 4th lumbar vertebra has been undergoing periodic examinations over a period of 18 years. Since then, the patient has been treated conservatively with bisphosphonates. When conservative treatment options have been exhausted, surgery was indicated due to a progressively reduced ability to walk. Surgery with undercutting decompression via laminotomy was performed. PD was confirmed by biopsy. Bisphosphonate treatment was continued pre- and postoperatively. Follow-up examinations showed an improvement in clinical outcome measures. CONCLUSIONS Conservative treatment remains the gold standard for PD with spinal involvement. This patient had been asymptomatic on bisphosphonate therapy for almost 17 years, but presented with new onset back pain. In such cases, fracture and rare conversion into sarcoma must be ruled out, and biopsy should be performed even in the absence of signs of malignancy. Currently, there are no clear treatment recommendations available in the literature regarding cases of PD with expansive growth and involvement of the spinal canal causing neurologic deficits. Furthermore, laminectomy has been shown to cause complications in up to 27% of cases with the risk of early postoperative death. In contrast, extended laminotomy and undercutting decompression should be considered.
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Affiliation(s)
- Alexander Hofmann
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Sabine Opitz
- Department of Pathology, University Hospital Leipzig, Liebigstr. 26, 04103, Leipzig, Germany
| | - Christoph Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Nicolas Heinz von der Höh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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17
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Regev GJ, Lador R, Salame K, Mangel L, Cohen A, Lidar Z. Minimally invasive spinal decompression surgery in diabetic patients: perioperative risks, complications and clinical outcomes compared with non-diabetic patients' cohort. Eur Spine J 2018; 28:55-60. [PMID: 30099670 DOI: 10.1007/s00586-018-5716-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/15/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Prior studies have documented an increased complication rate in diabetic patients undergoing spinal surgery. However, the impact of diabetes on the risk of postoperative complications and clinical outcome following minimally invasive spinal (MIS) decompression is not well understood. OBJECTIVES To compare complication rates and outcomes of MIS decompression in diabetic patients with a cohort of non-diabetic patients undergoing similar procedures. METHODS Medical records of 48 patients with diabetes and 151 control patients that underwent minimally invasive lumbar decompression between April 2009 and July 2014 at our institute were reviewed and compared. Past medical history, the American Society of Anesthesiologists score, perioperative mortality, complication and revision surgeries rates were analyzed. Patient outcomes included: the visual analog scale and the EQ-5D scores. RESULTS The mean age was 68.58 ± 11 years in the diabetic group and 51.7 ± 17.7 years in the control group. No major postoperative complications were recorded in either group. Both groups were statistically equivalent in their postoperative length of stay, minor complications and revision rates. Both groups showed significant improvement in their outcome scores following surgery. CONCLUSIONS Our results indicate that minimally invasive decompressive surgery is a safe and effective treatment for diabetic patients and does not pose an increased risk of complications. Future prospective studies are necessary to validate the specific advantages of the minimally invasive techniques in the diabetic population. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- G J Regev
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Lador
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Salame
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Mangel
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Cohen
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Lidar
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Pennington Z, Zygourakis C, Ahmed AK, Kalb S, Zhu A, Theodore N. Immediate improvement of intraoperative monitoring signals following CSF release for cervical spine stenosis: Case report. J Clin Neurosci 2018; 53:235-237. [PMID: 29716808 DOI: 10.1016/j.jocn.2018.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative pathology characterized by partial or complete conduction block on intraoperative neuromonitoring. We describe a case treated using osseoligamentous decompression and durotomy for cerebrospinal fluid (CSF) release. Intraoperative monitoring demonstrated immediate signal improvement with CSF release, suggesting that clinical improvement in CSM may result from resolution of CSF flow anomalies.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Corinna Zygourakis
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Alex Zhu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
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19
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Abstract
PURPOSE OF REVIEW Current guidelines for the optimal treatment degenerative spondylolisthesis are weak and based on limited high-quality evidence. RECENT FINDINGS There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.
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Affiliation(s)
- Andre M Samuel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Harold G Moore
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Matthew E Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
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20
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Huynh TR, Lagman C, Sweiss F, Shweikeh F, Nuño M, Drazin D. Pediatric spondylolysis/spinal stenosis and disc herniation: national trends in decompression and discectomy surgery evaluated through the Kids' Inpatient Database. Childs Nerv Syst 2017; 33:1563-70. [PMID: 28643037 DOI: 10.1007/s00381-017-3471-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to describe national trends in spinal decompression without fusion and discectomy procedures in the US pediatric inpatient population. METHODS The Kids' Inpatient Database (KID) was queried for pediatric patients with primary diagnoses of spinal spondylolysis/stenosis or disc herniation and having undergone spinal decompression without fusion or discectomy over more than a decade (2000 to 2012). The primary (indirect) outcomes of interest were in-hospital complication rates, length of stay (LOS), total costs, and discharge dispositions. RESULTS A total of 7315 patients, comprised of pediatric spinal spondylolysis/stenosis (n = 287, 3.92%) and pediatric disc herniation (n = 7028, 96.1%) patients, were included in the study. During the years 2000 to 2012, diagnoses of pediatric spondylolysis/spinal stenosis increased from 61 to 90 diagnoses per 3-year period, while diagnoses of pediatric disc herniation decreased from 2133 to 1335 diagnoses per 3-year period. Spinal decompression was associated with higher in-hospital complication rates (18.1 vs 5.3%, p < 0.0001), longer hospital stays (5 vs 1.69 days, p < 0.0001), higher mean total charges ($49,186 vs $19,057, p < 0.0001), and higher non-routine discharge rates (12.3 vs 2.5%, p < 0.0001) versus discectomy. CONCLUSIONS Spinal decompression is associated with longer hospital stays, more complications, higher costs, and more non-routine discharges when compared to discectomy. The data supports the disparate nature of these disease processes and elucidates basic clinical trends in uncommon spinal disorders affecting children.
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21
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Schnake KJ. TPLIF (decompression and TLIF) in degenerative spondylolisthesis L4/5. Eur Spine J 2016; 25 Suppl 2:272-273. [PMID: 26931329 DOI: 10.1007/s00586-016-4480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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22
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Khashan M, Lidar Z, Salame K, Mangel L, Lador R, Drexler M, Sapirstein E, Regev GJ. Minimally Invasive Spinal Decompression in Patients Older Than 75 Years of Age: Perioperative Risks, Complications, and Clinical Outcomes Compared with Patients Younger Than 45 Years of Age. World Neurosurg 2016; 89:337-42. [PMID: 26875656 DOI: 10.1016/j.wneu.2016.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Minimally invasive spinal decompression for the treatment of spinal stenosis or disk herniation is often indicated if conservative management fails. However, the influence of old age on the risk of postoperative complications and clinical outcome is not well understood. We therefore sought to compare complication rates and outcomes after minimally invasive surgery decompression and discectomy in elderly patients with a cohort of younger patients undergoing similar procedures. METHODS We evaluated medical records of 61 patients older than 75 years and 69 patients younger than 45 years that underwent minimally invasive lumbar decompression between April 2009 and July 2013 at our institute. Medical history, American Society of Anesthesiologists score, perioperative mortality, complications, and revision surgery rates were analyzed. Patient outcomes included visual analog scale and EuroQol-5 Dimension scores. RESULTS The average age was 78.66 ± 4.42 years in the elderly group and 33.59 ± 6.7 years in the younger group. No major postoperative complications were recorded in either group, and all recruited patients were still alive at the time of the last follow-up. No statistically significant difference existed in the surgical revision rate between the groups. Both groups showed significant improvement in their outcome scores after surgery. CONCLUSIONS Our results indicate that minimally invasive decompressive surgery is a safe and effective treatment for elderly patients and does not pose an increased risk of complications. Future prospective studies are necessary to validate the specific advantages of the minimally invasive techniques in the elderly population.
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Affiliation(s)
- Morsi Khashan
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Zvi Lidar
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Laurence Mangel
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Lador
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eilat Sapirstein
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad J Regev
- Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Ramesh A, Lyons F, Kelleher M. Aperius interspinous device for degenerative lumbar spinal stenosis: a review. Neurosurg Rev 2015; 39:197-205; discussion 205. [PMID: 26324829 DOI: 10.1007/s10143-015-0664-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/27/2015] [Indexed: 11/26/2022]
Abstract
With an aging population, degenerative lumbar spinal stenosis (DLSS) leading to neurogenic intermittent claudication (NIC) is a growing problem. For patients suffering from this condition, interspinous process distraction devices (IPDs) offer an effective and cheap alternative to conservative or decompressive surgery. Aperius is one such device that has been gaining popularity for its percutaneous insertion under local anesthetic, short operative time, and low risk of complications. The main objective of this review was to carry out a comprehensive search of the literature to evaluate the effectiveness and potential complications of Aperius. A database search, including PubMed, Clinical trials.gov, Cochrane (CENTRAL), MEDLINE, CINAHL, EMBASE, and Scopus, was carried out to identify relevant articles written in English reporting on complications with a minimum 12-month follow-up. The literature search resulted in six eligible studies; two nonrandomized comparative and four prospective case series were available. The analysis revealed that in total, 433 patients underwent treatment with Aperius, with all studies demonstrating an improvement in outcome measures. The average follow-up was 17 months with an overall complication rate of 10.62%. Overall, the quality of evidence is low, suggesting that currently, the evidence is not compelling and further prospective randomized trials including cost-effectiveness studies are required.
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Affiliation(s)
- Ashwanth Ramesh
- RCSI, Department of Anatomy, St. Stephens Green, Dublin 2, Ireland.
| | - Frank Lyons
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
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Sarkiss CA, Fogg GA, Skovrlj B, Cho SK, Caridi JM. To operate or not?: A literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery. Clin Neurol Neurosurg 2015; 134:122-5. [PMID: 25988602 DOI: 10.1016/j.clineuro.2015.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 03/19/2015] [Accepted: 04/25/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with Parkinson's disease. Surgical treatment with spinal fusion can be complicated due to poor bone quality and muscular dysfunction in this patient population. The goal of this paper is to investigate surgical outcomes in Parkinson's patients undergoing spine surgery. METHODS We performed a literature review using the PubMed and Google Scholar search engines investigating "Parkinson's disease and spinal fusion surgery" from the period of 2000 to 2013. The inclusion criteria included only English articles with Parkinson's patients that underwent spinal surgery. We identified and reviewed all six articles that included ninety-five patients with Parkinson's disease who underwent spinal surgery. RESULTS A total of 95 patients with Parkinson's disease who underwent spinal fusion surgery were reviewed with average patient age of 69 and a 3:4 male to female ratio. With an average follow up of 40 months, 46 out of 73 patients (63%) were judged to have satisfactory outcomes with poor outcomes noted in the remaining 37%. These included but were not limited to pseudoarthrosis, hardware failure/pullout, development of adjacent level disease, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. There was a 45% (29/65) revision rate and a 59% (30/51) complication rate following the index procedure. CONCLUSION It remains unclear whether Parkinson's patients benefit from spinal fusion surgery. Further prospective research is warranted to investigate surgical outcomes in this subset of patients.
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Affiliation(s)
| | - Guy A Fogg
- Saba University School of Medicine, Saba, Bonaire, Sint Eustatius and Saba
| | - Branko Skovrlj
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, USA
| | - Samuel K Cho
- Icahn School of Medicine at Mount Sinai, Department of Orthopedic Surgery, New York, USA
| | - John M Caridi
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, USA
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Buerba RA, Fu MC, Gruskay JA, Long WD, Grauer JN. Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database. Spine J 2014; 14:2008-18. [PMID: 24316118 DOI: 10.1016/j.spinee.2013.11.047] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/27/2013] [Accepted: 11/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Prior studies on the impact of obesity on spine surgery outcomes have focused mostly on lumbar fusions, do not examine lumbar discectomies or decompressions, and have shown mixed results regarding complications. Differences in sample sizes and body mass index (BMI) thresholds for the definition of the obese versus comparison cohorts could account for the inconsistencies in the literature. PURPOSE The purpose of the study was to analyze whether different degrees of obesity influence the complication rates in patients undergoing lumbar spine surgery. STUDY DESIGN/SETTING This was a retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2010. PATIENT SAMPLE Patients in the de-identified, risk-adjusted, and multi-institutional ACS NSQIP database undergoing lumbar anterior fusion, posterior fusion, transforaminal lumbar interbody fusion/posterior lumbar interbody fusion (TLIF/PLIF), discectomy, or decompression were included. OUTCOME MEASURES Primary outcome measures were 30-day postsurgical complications, including pulmonary embolism and deep vein thrombosis, death, system-specific complications (wound, pulmonary, urinary, central nervous system, and cardiac), septic complications, and having one or more complications overall. Secondary outcomes were time spent in the operating room, blood transfusions, length of stay, and reoperation within 30 days. METHODS Patients undergoing lumbar anterior fusion, posterior fusion, TLIF/PLIF, discectomy, or decompression in the ACS NSQIP, 2005 to 2010, were categorized into four BMI groups: nonobese (18.5-29.9 kg/m(2)), Obese I (30-34.9 kg/m(2)), Obese II (35-39.9 kg/m(2)), and Obese III (greater than or equal to 40 kg/m(2)). Obese I to III patients were compared with patients in the nonobese category using chi-square test and analysis of variance. Multivariate linear/logistic regression models were used to adjust for preoperative risk factors. RESULTS Data were available for 10,387 patients undergoing lumbar surgery. Of these, 4.5% underwent anterior fusion, 17.9% posterior fusion, 6.3% TLIF/PLIF, 40.7% discectomy, and 30.5% decompression. Among all patients, 25.6% were in the Obese I group, 11.5% Obese II, and 6.9% Obese III. On multivariate analysis, Obese I and III had a significantly increased risk of urinary complications, and Obese II and III patients had a significantly increased risk of wound complications. Only Obese III patients, however, had a statistically increased risk of having increased time spent in the operating room, an extended length of stay, pulmonary complications, and having one or more complications (all p<.05). CONCLUSIONS Patients with high BMI appear to have higher complication rates after lumbar surgery than patients who are nonobese. However, the complication rates seem to increase substantially for Obese III patients. These patients have longer times spent in the operating room, extended hospitals stays, and an increased risk for wound, urinary, and pulmonary complications and for having at least one or more complications overall. Surgeons should be aware of the increased risk of multiple complications for patients with BMI greater than or equal to 40 kg/m(2).
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Affiliation(s)
- Rafael A Buerba
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Michael C Fu
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Jordan A Gruskay
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - William D Long
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA.
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