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Zhong J, Tareen J, Ashayeri K, Leon C, Balouch E, O'Malley N, Stickley C, Maglaras C, O'Connell B, Ayres E, Fischer C, Kim Y, Protopsaltis T, Buckland AJ. Does Bone Morphogenetic Protein Use Reduce Pseudarthrosis Rates in Single-Level Transforaminal Lumbar Interbody Fusion Surgeries? Int J Spine Surg 2024:8590. [PMID: 38569928 DOI: 10.14444/8590] [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] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Recombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown. OBJECTIVE To assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP. METHODS This was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression. RESULTS One hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis. CONCLUSIONS BMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis. CLINICAL RELEVANCE BMP is frequently used "off-label" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Jack Zhong
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Jarid Tareen
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Kimberly Ashayeri
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Carlos Leon
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Eaman Balouch
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Nicholas O'Malley
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Carolyn Stickley
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | | | - Brooke O'Connell
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Ethan Ayres
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Charla Fischer
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | - Yong Kim
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
| | | | - Aaron J Buckland
- Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA
- Melbourne Orthopedic Group, Melbourne, Australia
- Spine and Scoliosis Research Associates Australia, Windsor, Australia
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Abstract
Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, Grundnes O, Algaard KRH, Böker T, Banitalebi H, Indrekvam K, Hellum C; NORDSTEN-DS Investigators. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med. 2021 Aug 5;385(6):526-538.
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Affiliation(s)
- Joseph R. Dettori
- Spectrum Research, Inc., Steilacoom, WA, USA,Joseph R. Dettori, Spectrum Research, Inc., Box
88998, Steilacoom, WA 98388, USA.
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Shahrestani S, Ballatori AM, Chen X, Ton A, Wang JC, Buser Z. The Impact of Osteobiologic Subtype Selection on Perioperative Complications and Hospital-Reported Charges in Single- and Multi-Level Lumbar Spinal Fusion. Int J Spine Surg 2021; 15:654-662. [PMID: 34266932 DOI: 10.14444/8086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Over the last several decades, various osteobiologics including allograft, synthetics, and growth factors have been used for lumbar spinal fusion surgery. However, the data on these osteobiologic products remain controversial with conflicting evidence in the literature. This study evaluates the influence of osteobiologic type selection on perioperative complications and hospital-reported charges in single-level and multilevel lumbar fusion. METHODS Using the 2016 and 2017 Nationwide Readmission Database, we conducted a retrospective cohort analysis of 125,143 patients who received lumbar fusion with either autologous tissue substitute, nonautologous tissue substitute, or synthetic substitute. This cohort was split into single-level and multilevel fusion procedures, and one-to-one age and sex propensity score matching was implemented. This resulted in cohorts each consisting of 1967 patients for single-level fusion, and cohorts each consisting of 1657 patients for multilevel fusion. Statistical analysis included one-way analysis of variance and Tukey multiple comparisons of means. RESULTS Autologous single-level fusion resulted in significantly more postoperative pain at 30-, 90-, and 180-day follow-up compared to fusion with nonautologous graft (P < .05). Multilevel fusion with autologous graft had higher rates of acute postsurgical anemia compared with synthetic (P = .021) and nonautologous (P = .016) alternatives, and less postsurgical infection when compared with nonautologous fusion (P = .0020). In addition, procedures using autologous osteobiologics were associated with significantly more neurological complications at 30 days (P = .049) and 90 days (P = .048) for multi-level fusion and at 30 days (P = .044) for single-level fusion compared with the nonautologous group. Lastly, for both cohorts, the total accrued inpatient hospital charges during admission for patients receiving nonautologous grafts were the most expensive and those for patients receiving autologous grafts were the least expensive. CONCLUSION Significant differences were found between the groups with respect to rates of complications, including infection, postoperative pain, and neurologic injury. Furthermore, the hospital-reported charges of each procedure varied significantly. As the field of biologics continues to expand, it is important to continually evaluate the safety, efficacy, and cost-effectiveness of these novel materials and techniques. LEVEL OF EVIDENCE 3 CLINICAL RELEVANCE: With increased utilization of osteobiologics and spinal fusion being a common procedure, longitudinal data on readmissions, and post-operative complications are critical in guiding evidence-based practice.
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Affiliation(s)
- Shane Shahrestani
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Alexander M Ballatori
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xiao Chen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Harada GK, Khan JM, Vetter C, Basques BA, Sayari AJ, Hayani Z, Tchalukov K, Louie PK, Colman M, An HS. Does the Number of Levels Fused Affect Spinopelvic Parameters and Clinical Outcomes Following Posterolateral Lumbar Fusion for Low-Grade Spondylolisthesis? Global Spine J 2021; 11:116-121. [PMID: 32875855 PMCID: PMC7734270 DOI: 10.1177/2192568220901527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis. METHODS This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale [VAS]-back, VAS-leg, Oswestry Disability Index [ODI]), and postoperative complications were compared. RESULTS Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions. CONCLUSIONS Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.
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Affiliation(s)
| | | | | | - Bryce A. Basques
- Rush University Medical Center, Chicago, IL, USA,Bryce A. Basques, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA.
| | | | - Zayd Hayani
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
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Beckerman D, Esparza M, Lee SI, Berven SH, Bederman SS, Hu SS, Burch S, Deviren V, Tay B, Mummaneni PV, Chou D, Ames CP. Cost Analysis of Single-Level Lumbar Fusions. Global Spine J 2020; 10:39-46. [PMID: 32002348 PMCID: PMC6963351 DOI: 10.1177/2192568219853251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Cost analysis of a retrospectively identified cohort of patients who had undergone primary single-level lumbar fusion at a single institution's orthopedic or neurosurgery department. OBJECTIVE The purpose of this article is to analyze the determinants of direct costs for single-level lumbar fusions and identify potential areas for cost reduction. METHODS Adult patients who underwent primary single-level lumbar fusion from fiscal years 2008 to 2012 were identified via administrative and departmental databases and were eligible for inclusion. Patients were excluded if they underwent multiple surgeries, had previous surgery at the same anatomic region, underwent corpectomy, kyphectomy, disc replacement, surgery for tumor or infection, or had incomplete cost data. Demographic data, surgical data, and direct cost data in the categories of supplies, services, room and care, and pharmacy, was collected for each patient. RESULTS The cohort included 532 patients. Direct costs ranged from $8286 to $73 727 (median = $21 781; mean = $22 890 ± $6323). Surgical approach was an important determinant of cost. The mean direct cost was highest for the circumferential approach and lowest for posterior instrumented spinal fusions without an interbody cage. The difference in mean direct cost between transforaminal lumbar interbody fusions, anterior lumbar interbody fusions, and lateral transpsoas fusions was not statistically significant. Surgical supplies accounted for 44% of direct costs. Spinal implants were the primary component of supply costs (84.9%). Services accounted for 38% of direct costs and were highly dependent on operative time. Comorbidities were an important contributor to variance in the cost of care as evidenced by high variance in pharmacy costs and length of stay related to their management. CONCLUSION The costs of spinal surgeries are highly variable. Important cost drivers in our analysis included surgical approach, implants, operating room time, and length of hospital stay. Areas of high cost and high variance offer potential targets for cost savings and quality improvements.
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Affiliation(s)
- Daniel Beckerman
- University of California San Francisco, San Francisco, CA, USA,Daniel Beckerman, University of California San Francisco, 500 Parnassus Avenue, MU317 W, San Francisco, CA 94143-0728, USA.
| | | | - Sun Ik Lee
- University of California San Francisco, San Francisco, CA, USA,Highland Hospital, Oakland, CA, USA
| | | | | | - Serena S. Hu
- University of California San Francisco, San Francisco, CA, USA
| | - Shane Burch
- University of California San Francisco, San Francisco, CA, USA
| | - Vedat Deviren
- University of California San Francisco, San Francisco, CA, USA
| | - Bobby Tay
- University of California San Francisco, San Francisco, CA, USA
| | | | - Dean Chou
- University of California San Francisco, San Francisco, CA, USA
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7
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Yan Y, Wu C, Huang C, Zhang Z, Wang J, Wu A, Wang X. The Presence of Thyroid Cartilage at the Surgical Level Reduces Early Dysphagia after Single-Level Anterior Cervical Surgery: A Retrospective Study. J INVEST SURG 2019; 33:365-374. [PMID: 30885032 DOI: 10.1080/08941939.2018.1520939] [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] [Indexed: 10/27/2022]
Abstract
Background: Early dysphagia is a frequent complication of anterior cervical (AC) spine surgery. However, there are no reports that have discussed the correlation between early dysphagia and the positional relationship between thyroid cartilage and the surgical level.Methods: We retrospectively enrolled 82 patients in our hospital who underwent single-level AC discectomy performed by the same surgeon using the same internal fixation apparatus from 2015 to 2017. Swallowing difficulty was rated during the first five postoperative days using a 10-point scoring system. The positional relationship between the thyroid cartilage and the surgical level was defined as discectomy within the thyroid cartilage (IN group) or outside the thyroid cartilage (OUT group) using preoperative computed tomography (CT) images. The confounding factors such as gender, age, body mass index (BMI), hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, and blood loss were analyzed by a binomial logistic regression.Results: The thyroid cartilage was most commonly located above the C5 level (65.1%). Early dysphagia developed in 47.6% of the patients during the first five postoperative days. The IN and OUT groups each contained 41 cases. The difference in the cumulative postoperative early dysphagia score between the IN and OUT groups was statistically significant (p < .05). The factors of gender, age, BMI, hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, blood loss did not significantly influence the incidence of postoperative early dysphagia.Conclusions: We found that early dysphagia, which is a self-limiting complication, was correlated with surgery performed at levels outside the thyroid cartilage region. Preoperative review of the positional relationship between the thyroid cartilage and the surgical level can predict the incidence of postoperative transient dysphagia.
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Affiliation(s)
- Yingzhao Yan
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, PR China
| | - Congcong Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
| | - Congan Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
| | - Zengjie Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
| | - Jianle Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
| | - Aimin Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
| | - Xiangyang Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Centre,, Wenzhou, PR China
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Lao L, Cohen JR, Buser Z, Brodke DS, Yoon ST, Youssef JA, Park JB, Meisel HJ, Wang JC. Trends Analysis of rhBMP2 Utilization in Single-Level Anterior Lumbar Interbody Fusion in the United States. Global Spine J 2018; 8:137-141. [PMID: 29662743 PMCID: PMC5898671 DOI: 10.1177/2192568217701119] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Retrospective case study. OBJECTIVE To evaluate the trends and demographics of recombinant human bone morphogenetic protein 2 (rhBMP2) utilization in single-level anterior lumbar interbody fusion (ALIF) in the United States. METHODS Patients who underwent single-level ALIF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database (PearlDiver Technologies, Fort Wayne, IN), a national database of orthopedic insurance records. The year of procedure, age, gender, and region of the United States were analyzed for each patient. RESULTS A total of 921 patients were identified who underwent a single-level ALIF in this study. The average rate of single-level ALIF with rhBMP2 utilization increased (35%-48%) from 2005 to 2009, but sharply decreased to 16.7% in 2010 and 15.0% in 2011. The overall incidence of single-level ALIF without rhBMP2 (0.20 cases per 100 000 patients) was more than twice of the incidence of single-level ALIF with rhBMP2 (0.09 cases per 100 000 patients). The average rate of single-level ALIF with rhBMP2 utilization is highest in West (41.4%), followed by Midwest (33.3%), South (26.5%) and Northeast (22.2%). The highest incidence of single-level ALIF with rhBMP2 was observed in the group aged less than 65 years (compared with any other age groups, P < .001), with an incidence of 0.21 per 100 000 patients. CONCLUSIONS The incidence of rhBMP2 utilization in single-level ALIF increased from 2006 to 2009, but decreased in 2010 and 2011. The Northeast region had the lowest incidence of rhBMP2 utilization. The group aged less than 65 years trended to have the higher incidence of single-level ALIF with rhBMP2 utilization.
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Affiliation(s)
- Lifeng Lao
- University of Southern California, Los Angeles, CA, USA,Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA,Zorica Buser, MD, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue, HMR 710, Los Angeles, CA 90033, USA.
| | | | | | | | - Jong-Beom Park
- Uijongbu St. Mary’s Hospital, The Catholic University of Korea, Uijongbu, Korea
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9
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Lao L, Cohen JR, Buser Z, Brodke DS, Youssef JA, Park JB, Yoon ST, Wang JC, Meisel HJ. Trends Analysis of rhBMP Utilization in Single-Level Posterior Lumbar Interbody Fusion in the United States. Global Spine J 2017; 7:624-628. [PMID: 28989840 PMCID: PMC5624372 DOI: 10.1177/2192568217699387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been widely used in spinal fusion surgery, but there is little information on rhBMP-2 utilization in single-level posterior lumbar interbody fusion (PLIF). The purpose of our study was to evaluate the trends and demographics of rhBMP-2 utilization in single-level PLIF. METHODS Patients who underwent single-level PLIF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database, a national database of orthopedic insurance records. The year of procedure, age, gender, and region of the United States were recorded for each patient. Results were reported for each variable as the incidence of procedures identified per 100 000 patients searched in the database. RESULTS A total of 2735 patients had single-level PLIF. The average rate of single-level PLIF with rhBMP-2 maintained at a relatively stable level (28% to 31%) from 2005 to 2009, but decreased in 2010 (9.9%) and 2011 (11.8%). The overall incidence of single-level PLIF without rhBMP-2 (0.68 cases per 100 000 patients) was statistically higher (P < .01) compared to single-level PLIF with rhBMP-2 (0.21 cases per 100 000 patients). The average rate of single-level PLIF with rhBMP-2 utilization was the highest in West (30.1%), followed by Midwest (26.9%), South (20.5%), and Northeast (17.8%). The highest incidence of single-level PLIF with rhBMP-2 was observed in the age group <65 years (0.3 per 100 000 patients). CONCLUSIONS To our knowledge, this is the first study to report on the demographics associated with rhBMP-2 use in single-level PLIF. There was a 3-fold increase in the rate of PLIF without rhBMP-2 compared to PLIF with rhBMP-2, with both procedures being mainly done in patients less than 65 years of age.
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Affiliation(s)
- Lifeng Lao
- University of California at Los Angeles, CA, USA,Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Hoffman Medical Research Center, 2011 Zonal Ave, HMR 710, Los Angeles, CA 90033, USA.
| | | | - Jim A. Youssef
- Durango Orthopedic Associates, P.C./Spine Colorado, Durango, CO, USA
| | - Jong-Beom Park
- Uijongbu St. Mary’s Hospital, The Catholic University of Korea, Uijongbu, Korea
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Abstract
The purpose of our study is to evaluate sagittal parameters in 2-level lumbar degenerative spondylolisthesis (DS) (TLDS).A total of 15 patients with TLDS, 40 patients with single-level DS (SLDS), and 30 normal volunteers as control were included in our study. All subjects performed on full spine X-ray. Two categorized data were analyzed: patient characteristics-age, sex, body mass index, radiographic parameters-pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sacral slope (SS), PI-LL, Cobb between the fifth thoracic vertebral and 12th thoracic vertebral (T5-T12), sagittal vertical axis (SVA) Cobb angle of spondylolisthesis level (CSL), ratio of PT to SS (PT/SS), CSL/LL, variation trend of SS over PI, and LL over PI.The PI (73.1° vs 52.9°), SS (50.8° vs 32.2°), LL (53.1° vs 46.9°), SVA (66.1 vs 22.0 mm), PI-LL (20.0° vs 6.0°), and CSL (23.6° vs 20.0°) in TLDS were significantly larger than these in SLDS. The PI (73.1° vs 40.6°), PT (22.3° vs 17.1°), SS (50.8° vs 23.5°), LL (53.1° vs 32.5°), PI-LL (20.0° vs 8.1°), and SVA (66.1 vs 17.0 mm) in TLDS were significantly larger than those in the normal group (NG). The PI (52.9° vs 40.6°), PT (21.0° vs 17.1°), SS (32.2° vs 23.5°), LL (46.9° vs 32.5°), and SVA (22.0 vs 17.0 mm) in SLDS were significantly higher than those in NG. However, PT/SS (44.0%), LL over PI (y = 0.39x + 24.25), SS over PI (y = 10.79 + 0.55x) were lower in TLDS than these in SLDS (63.8%, y = 0.41x + 25, y = 0.65x - 2.09, respectively), and the similar tend between SLDS and NG (74.0%, y = 0.49x + 13.09, y = 0.67x - 3.9, respectively).Our results showed that 2-level lumbar DS, which was caused by multiple-factors, has a severe sagittal imbalance, but single-level has not any. When we plan for surgical selection for 2-level lumbar DS, global sagittal balance must be considered.
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11
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Epstein NE, Schwall GS, Hood DC. The incidence and cost of devices explanted during single-level anterior diskectomy/fusions. Surg Neurol Int 2011; 2:23. [PMID: 21427790 PMCID: PMC3050067 DOI: 10.4103/2152-7806.77033] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Little is known about the costs of devices explanted during anterior cervical diskectomy and fusion surgery. This retrospective study analyzes the costs to a single hospital of plates, screws and spacers used in all single-level anterior diskectomy and fusion (single-ADF) operations performed during a 1-year period. MATERIALS AND METHODS Our objective was to determine the costs of instrumentation explanted (i.e. implanted during surgery but removed prior to closure) during 87 single-ADF procedures performed at a single institution within a single year, 2009. All 87 single-ADF procedures were analyzed to determine the frequency and costs (without overhead) to the hospital for both permanently implanted and explanted anterior cervical screws, plates, and spacers (allograft, artificial plastics, and cages). All patients undergoing single-ADF were included in this study irrespective of the diagnosis related group (DRG) category. RESULTS THE COSTS, WITHOUT OVERHEAD TO THE HOSPITAL, FOR THE PERMANENTLY IMPLANTED INSTRUMENTATION WERE: screws ($103,572: 84 patients); plates ($120,694: 85 patients); allograft spacers ($92,776: 64 patients); cages ($38,821: 9 patients); and autografts (no charge; 14 patients), for a total of $355,863. The additional costs to the hospital for explanted instrumentation were: 37 screws ($11,014: 17 patients); 7 plates ($12,743: 5 patients); and 8 allograft spacers ($9093: 7 patients); there were no explanted cages. The total cost of the explanted devices was $32,850. CONCLUSIONS During 87 single-ADF procedures, a total of 37 screws, 7 plates, and 8 spacers were explanted in 24 (27.6%) patients, resulting in an additional $32,850, 9.2%, to the cost of the implanted devices.
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Affiliation(s)
- Nancy E Epstein
- Department of Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY, USA
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