Spinal Fusion Research Articles

Perioperative Outcomes Related to Thoracic and Lumbar Spine Exposure During Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Large, Single-institution Retrospective Review

BackgroundVertebral body tethering (VBT) is a novel non-fusion technique for the management of scoliosis. Despite growing popularity, data concerning complications and thoracic surgery-related outcomes are lacking. MethodsA single-institution retrospective review was conducted of patients who underwent VBT with video-assisted thoracic surgical exposure from 1/1/2015–3/1/2022. Data obtained included demographics, comorbidities, hospital course, and outcomes. Results106 patients (81 % female) were identified with a mean age at surgery of 12.7 ± 1.5 (range 9–16). Most patients underwent single curve tethering (n = 93, 87.7 %) with a mean number of vertebral bodies tethered of 8.0 (range 5–13). The mean operative time was 236 ± 96 min (range 129–661) minutes with an estimated blood loss of 165 ± 143 mL (range 20–750) and no patients required allogeneic blood transfusion. The extent of tethering was significantly associated with increased operative time, fluids received, and chest tube output. Excluding instrument-related complications, the complication rate was 13.2 %, mostly occurring within the first 30 days after surgery and pleural effusion being the most common event. Two patients experienced a postoperative hemothorax requiring reoperation. No patients experienced sequelae of spinal cord ischemia secondary to the division of intercostal and/or lumbar vessels during surgical exposure and no deaths occurred. ConclusionVBT is a seemingly safe alternative to spinal fusion in skeletally immature adolescents, however, there are notable complications of this procedure related to thoracic exposure. Our experience indicates clinically significant pulmonary complications are uncommon and the extent of vertebral body exposure/tethering was strongly associated with operative duration, fluids, and chest tube output. Levels of EvidenceThis original article represents a treatment study of Level IV evidence.

Efficacy and safety of short segment pedicle screw fixation in patients with neurologically intact burst fractures of the lower thoracic and lumbar spine: a meta-analysis of studies published over the last 20 years

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group.Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method.Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %.Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Nomogram to Assess the Risk of Deep Venous Thrombosis After Posterior Lumbar Fusion: A Retrospective Study.

Retrospective cohort study. Deep venous thrombosis (DVT) is a common complication following lumbar spine surgery, which can lead to adverse consequences such as venous thromboembolism and pulmonary embolism. This study aimed to investigate whether predictors of DVT can improve clinical interventions. The study included patients who underwent posterior lumbar fusion between 2012 and 2022. In the training cohort, stepwise logistic regression, based on the Akaike information criterion minimum, was used to identify variables for constructing the nomogram. The nomogram was evaluated and validated using calibration curves, Brier scores, receiver operating characteristic (ROC) curves, C-index, decision curve analyses (DCAs), clinical impact curves (CICs), and risk stratification analyses. A total of 9216 patients were enrolled after screening. The nomogram included seven variables: cerebrovascular disease, diabetes, body mass index, age, pedicular screw quantity, D-dimer, and hypertension. Calibration plots demonstrated favorable agreement between predicted and observed probabilities. The C-index indicated satisfactory discriminatory ability of the nomogram (0.772 for the training cohort and 0.792 for the validation cohort). Additionally, the DCA and CIC revealed that the nomogram could provide clinical benefits for patients. This study successfully developed and validated a nomogram that can assess the risk of DVT following posterior lumbar fusion. The nomogram will assist surgeons in making informed clinical decisions.

Changes in Diaphragm Intrusion and Thoracic Dimensions After Posterior Spinal Fusion in Patients With Neuromuscular Scoliosis.

Cerebral palsy (CP) can cause scoliosis with large thoracolumbar or lumbar curves. Such curves may impair pulmonary function by causing the abdomen and diaphragm to encroach on the thorax. Our purpose was to investigate changes in diaphragm position and other thoracic radiographic measurements at 2 years after posterior spinal fusion (PSF). Retrospective review of data from 56 pediatric patients (Gross Motor Function Classification System >3) who underwent PSF for CP-related (neuromuscular) scoliosis at one US academic hospital from 2010 to 2018. In this study, we used radiographs taken preoperatively and 2 years after PSF to measure lung volume, diaphragm intrusion index (DII), diaphragm vertebral level (DVL), space available for the lung (SAL), and T1-S1 height. Lung volume had increased by a mean 902cm3 (range, -735 to 2697cm3) at 2-year follow-up. DII improved from a mean (and SD) of 61%±12% to 71%±11% on the left side and 58%±14% to 68%±11% on the right (P<0.001). DVL increased caudally by a mean 1.2 vertebral levels bilaterally, with a mean postoperative position between T8 and T9. Lung space became more symmetrical as the SAL increased from 0.76 to 0.91 (P<0.001). T1-S1 height increased by a mean 7.5±4.3cm. These findings suggest a new way to understand changes in thoracic volume and redistribution of thoracic and lumbar balance when correcting the collapsing spinal deformity in CP. A more caudal postoperative diaphragm position with less diaphragm intrusion into the thorax may reflect an improved length-tension configuration, which could in turn produce greater diaphragmatic strength and endurance. Level III.

Effective use of actifuse shape in spinal fusion: A retrospective chart review

Introduction: This study aimed to assess the safety and clinical performance of Actifuse Shape for spine surgery. Method: A retrospective real-world data study was conducted in two research sites in the U.S. Patient medical records had to show evidence of implantation with Actifuse Shape in 1-2 levels or 2 or more levels cervical (C2 or lower), in either posterolateral thoraco-lumbar or lumbar spine fusion procedures, among other eligibility criteria. All fusion assessments were completed using the Glassman 5 grade fusion scale. Results: Fifty-five (55) medical records were included in the full analysis set, and of these, 42 were eligible, achieving 97.6% bone fusion with a 95% CI (87.4%, 99.9%). Fusion success rates (Grade 4 or 5): 6 mo 72.7% (n=8/11), 12 mo 97.6% (n=41/42) and 24 mo 100% (n=49/49). No device-related adverse events were reported for Actifuse Shape. A “worst-case” imputation post hoc analysis was performed to take into account five patients who did not show evidence of fusion at 6 mo and were lost to follow up and were assumed to continue showing no evidence of fusion throughout the remaining study period. Forty-one out of 47 (87.2%) patients (95% CI: 74.3, 95.2) achieved successful fusion at 12 mo (±60 days) and 49/55 (89.1%) patients (95% CI: 77.8, 95.9) achieved successful fusion at 24 mo (+60 days). Conclusions: Actifuse Shape is safe and is associated with high rate of bony fusion when implanted as the primary bone graft substitute in spinal fusion surgeries.

Mechanism of low-intensity pulse ultrasound combined with Rhodiola to promote bone formation in spinal fusion.

This study aimed to explore the influence and mechanism of low-intensity pulsed ultrasound (LIPUS) combined with Rhodiola bone penetration on the formation of spinal fusion bone. Sixty clean-grade New Zealand white rabbits were selected for randomization and divided into combined group and Rhodiola group, with 30 rabbits in each group to construct a rabbit lumbar intervertebral fusion model, using Rhodiola intervention and Rhodiola combined with LIPUS intervention protocol, respectively. The axial strength, axial stiffness, maximum compressive load, vascular endothelial growth factor (VEGF), cycloxygenase-2 (COX-2), prostaglandin E2 (PGE2) and transforming growth factor-β (TGF-β) were compared after HE staining, immunohistochemistry and biomechanical detection. Spine fusion rate was 100.00%; the combined bone graft tissue had implanted bone cell degeneration, cell necrosis and cell hyperplasia, chondrocytes differentiated into trabecular bone and some hematopoietic cells, severe cell necrosis and fiber cell proliferation and late bone formation in the Rhodiola group, VEGF, COX-2, PGE2, TGF-β, axial strength, axial stiffness, and maximum compression load in the combined group significantly increased (P<0.05). Spinal fusion using LIPUS combined with Rhodiola can enhance biomechanical properties and promote the role of PGE2, COX-2, VEGF, TGF-β expression and bone formation, and this protocol is worthy of clinical application.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Robotic-Assisted Navigation in Single-Level Transforaminal Lumbar Interbody Fusion Reduces Surgeons’ Mental Workload Compared With Fluoroscopic and Computed Tomographic Techniques: A Nonrandomized Prospective Controlled Trial

Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being. Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement. Methods: We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration–Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed. Results: Surgeons’ self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance. Conclusions: This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness.

Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction: A retrospective study.

Posterior spinal instrumentation and fusion is an established surgical procedure for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring is standard practice for this procedure. Anesthetic agents can have different, but significant, effects on neurophysiological monitoring outcomes. To determine if intravenous lidocaine infusion therapy has an impact on the intraoperative neurophysiological monitoring during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Following ethical approval, we conducted a retrospective review of charts and the archived intraoperative neurophysiological data of adolescents undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring data included the amplitude of motor evoked potentials and the amplitude and latency of somatosensory evoked potentials. A cohort who received intraoperative lidocaine infusion were compared to those who did not. Eighty-one patients were included in this analysis, who had surgery between February 4, 2016 and April 22, 2021: 39 had intraoperative intravenous lidocaine infusion and 42 did not. Based on hourly snapshot data, there was no evidence that lidocaine infusion had a detrimental effect on the measured change from baseline for MEP amplitudes in either lower (mean difference 41.9; 95% confidence interval -304.5 to 388.3; p = .182) or upper limbs (MD -279.0; 95% CI -562.5 to 4.4; p = .054). There was also no evidence of any effect on the measured change from baseline for SSEP amplitudes in either lower (MD 16.4; 95% CI -17.7 to 50.5; p = .345) or upper limbs (MD -2.4; 95% CI -14.5 to 9.8; p = .701). Finally, there was no evidence of a difference in time to first reportable neurophysiological event (hazard ratio 1.13; 95% CI 0.61 to 2.09; p = .680). Data from these two cohorts provide preliminary evidence that intravenous lidocaine infusion has no negative impact on intraoperative neurophysiological monitoring during PSIF for adolescent idiopathic scoliosis.

Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs. titanium.

Spine metastases are a major burden of oncologic care, contributing to substantial morbidity. A well-established treatment paradigm for patients with metastatic epidural spinal cord compression includes separation surgery followed by stereotactic body radiotherapy (SBRT). Innovations in implant technology have brought about the incorporation of Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation for spinal fixation. We present our experience of CFR-PEEK instrumentation, comparing outcomes and complication profiles with a matched cohort of titanium instrumented cases for spine metastatic disease. Oncology patients who underwent spinal fusion for metastatic spine disease from 2012 to 2023 were retrospectively reviewed. Ninety-nine cases with CFR-PEEK fusions were case-control matched with 50 titanium controls (2:1 ratio) based upon primary tumor type and spinal instability neoplastic score (SINS) location. Demographic, clinical, radiographic and progression free survival (PFS) were analyzed. In the study years, 263 patients underwent spinal decompression and fusion, for which 148 patients met predetermined inclusion criteria. Of these, 49 had titanium instrumentation, and 99 had CFR-PEEK. Complication profiles, including hardware failure and infection were similar between the groups. There was no significant difference in PFS between all CFR-PEEK and titanium patients (143 days versus 214 days; p = 0.41). When comparing patients in which recurrence was noted, CFR-PEEK patients had recurrence detected two times earlier than titanium patients (94 days versus 189 days; p = 0.013). In this case matched cohort, CFR-PEEK demonstrated decreased overall PFS suggestive of earlier local recurrence identification. Long-term studies are warranted for better evaluation of the impact on survival and systemic disease progression.

Worm-like necrotic inflammatory substance in Jackson-Pratt drain after spinal fusion

Worm-like necrotic inflammatory substance in Jackson-Pratt drain after spinal fusion

Impact of landmark crater creation on improving accuracy of pedicle screw insertion in robot-assisted scoliosis surgery.

This study evaluated the impact of the Landmark Crater (LC) method on pedicle perforation rates in robot-guided surgery for pediatric scoliosis for each pedicle diameter. Seventy-six scoliosis patients underwent robot-assisted posterior spinal fusion. The cohort consisted of 19 male and 57 female patients, with a mean ± standard deviation age of 17.5 ± 7.7 years and a preoperative Cobb angle of 57.0 ± 18.5°. The LC method is a method in which craters that serves as a landmark are created in advance at the planned PS insertion site of all pedicles within the intraoperative CT imaging area. The patients were divided into the LC group, in which PS insertion was performed using the LC method, and the control group using the conventional PS insertion method. Overall and pedicle perforation rates for each pedicle outer diameter were compared between the groups by Fisher's exact test. The LC group exhibited a significantly lower pedicle major perforation rate than did the control group (2.7% vs. 6.2%, P = 0.001). The perforation rates in pedicles with a pedicle outer diameter > 6mm, 4-6mm, 2-4mm, and < 2mm were 0.61%, 1.6%, 5.1%, and 21%, in the LC group and 0.75%, 4.1%, 12%, and 50% in the control group, respectively. In robot-assisted surgery for pediatric scoliosis, the LC method enabled significantly lower pedicle perforation rates over the conventional method. Both the LC and conventional methods exhibited higher perforation rates for smaller pedicle diameters.

Preoperative halo-gravity traction combined with one-stage posterior spinal fusion surgery following for severe rigid scoliosis with pulmonary dysfunction: a cohort study

BackgroundTo assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status.MethodsThis study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT.ResultsA total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 ± 7.96 (range 12–29) years. Among them, 20 patients were aged ≤ 16 years. The traction weight started from 1.5 kg and raised to 45.2 ± 13.2% of body weight on average progressively, with the average traction duration of 129 ± 63 days. After traction, the main curve was corrected from an average of 120.66 ± 3.89° to 94.88 ± 3.35°, and to 52.33 ± 22.36° (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 ± 14.76% vs. 47.33 ± 16.04%, 41.87 ± 13.68% vs. 45.19 ± 15.57%, and 40.44 ± 15.87% vs. 45.24 ± 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 ± 5.43 g/L to 70.68 ± 6.98 g/L and 42.40 ± 3.44 g/L 45.72 ± 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction.ConclusionsHalo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.

Prevalence and Clinical Impact of Coronal Malalignment Following Circumferential Minimally Invasive Surgery (CMIS) for Adult Spinal Deformity Correction.

Retrospective study. To determine prevalence and clinical importance of patients who had postoperative CM after CMIS for ASD correction. We reviewed patients who underwent CMIS technique. Inclusion criteria were patients who were diagnosed with ASD, which is defined as having at least one of the following: coronal Cobb angle >20, SVA >50mm, PI-LL >10, PT >20. They underwent >4 spinal levels fusion with CMIS technique and had at least 1-year follow-up. Preoperative and 1-year postoperative radiographs and clinical outcome measures (VAS, ODI, and SRS-22 scores) were used to make the comparisons. 120 patients were included. Radiographic outcomes, including CVA, coronal Cobb angle, LSF curve, SVA, LL, and PI-LL, and clinical outcomes, were significantly improved postoperatively in each of the 3 preoperative subgroups (Bao type A, B, and C). At 1-year post-operation, 10 patients (12.4 %) of type A turned out to be CM, 4 patients (21.1%) of type B, and 8 patients (40%) of type C remained CM. Comparing coronally aligned (CA) to coronally mal-aligned patients at 1-year follow-up in each coronal subtype revealed that clinical and radiographic outcomes were comparable. CMIS technique significantly improves radiographic and clinical outcomes for ASD patients. Incidence rates of postoperative CM were similar to open surgery. Type C patients were at risk of postoperative CM than types A and B. However, most 1-year outcomes were not significantly different between postoperative CA and CM patients regardless of the preoperative coronal alignment characteristics except ODI scores in type A.

Liposomal bupivacaine plus intrathecal hydromorphone associated with shortened length of stay and decreased opioid use in pediatric patients following posterior spinal fusion surgery.

We aimed to determine if the use of intrathecal (IT) hydromorphone and/or liposomal bupivacaine (LB) decreased the amount of postoperative and post-discharge opioids for pediatric patients undergoing fusion (PSF) surgery to treat adolescent idiopathic scoliosis (AIS). A retrospective review of AIS patients undergoing PSF surgery was conducted. Hospital LOS, and inpatient and post-discharge opioid use were compared. Opioid use was reported as oral morphine equivalents (OMEs). Three groups were formed from 186 patients: the control (CG) (n = 39), the IT hydromorphone only (IT) (n = 58), and the liposomal bupivacaine with intrathecal hydromorphone (LB + IT) group (n = 89). The mean LOS were 4.8, 4.2, and 3.5 days for the CG, IT, and LB + IT groups, respectively, with the LB + IT group being shorter than both the CG (p < 0.001) and IT groups (p < 0.001). The mean inpatient OMEs were 106.3/day, 69.2/day, and 30.0/day for the CG, IT, and LB + IT groups, respectively, with each group being significantly different than each other (all pairwise comparisons, p < 0.001). The mean total OMEs that patients were prescribed post-discharge were 693.6 in the CG, 581.1 in the IT, and 359.4 in the LB + IT group (F(2,183) = 14.5, p < 0.001), with the LB + IT group being prescribed significantly less than both the IT (p = 0.003) and CG groups (p < 0.001). Both the use of IT hydromorphone and LB were associated with shortened LOS and fewer total and per day in-hospital OMEs; however, the group who received both IT and LB (LB + IT) had the greatest decrease in LOS, and both inpatient and post-discharge OME usage. Level III (retrospective comparative study).

Managing Cerebrospinal Fluid Leak After Lumbar Spinal Fusion: When Conservative Treatment is Not the Answer?

IntroductionCSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks. MethodsThe Nationwide Inpatient Sample (NIS) database was used to identify patients who had lumbar fusion in the United States from 2002 to 2014. Inpatient outcomes including the incidence and risk factors for requiring an intervention were calculated. Secondary outcomes including average length of stay (LOS), mean cost, and mortality rates were calculated. All statistical analyses were conducted based on multivariate regression models using the SPSS software. ResultsA total of 11,636 patients with post-operative CSF leak after elective lumbar fusion were identified in the NIS database from 2002 to 2014. Of these patients, 79.9% (9,294/11,636) required an advanced intervention including epidural blood patch, simple repair, or operative management. There was an increase of 13% per year in the use of an intervention in managing CSF leaks. After controlling for several confounding factors, independent risk factors for requiring an intervention included: older age (OR: 1.01; 95% CI: 1.005-1.013; p<0.0001), lateral approach (OR: 1.52; 95% CI: 1.26-1.81; p<0.0001) and posterior approach (OR: 1.60; 95% CI: 1.34-1.91; p<0.0001) compared to anterior approach.Nonsurgical treatment was associated with increased length of stay (5.93±4.61 vs. 5.25±3.63;p<0.0001) with similar hospitalization costs (119,537.2±89,045.6 vs. 120,277.9±87,894.1; p=0.72) and mortality (0.3% vs. 0.3%; p>0.05). ConclusionSpine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.

Hip Surgery is Not More Painful Than Spine Surgery in Children With Cerebral Palsy.

Posterior spinal fusion (PSF) and hip reconstruction are commonly indicated surgeries in children with cerebral palsy (CP), particularly those functioning at GMFCS levels IV and V. These are large and often painful procedures, and previous literature suggests that hip surgery is more painful than spine surgery in this patient population. The purpose of this study is to investigate pain scores and opioid use following hip and spine surgery in a large cohort of children with CP, including many patients who have undergone both types of surgery. A retrospective chart review was performed to identify children with CP who underwent hip reconstruction and/or PSF at a tertiary children's hospital between 2004 and 2022. Charts were reviewed for demographic data, pain scores, pain medication usage, duration of hospital stay, and complications. Data were collected for 200 patients (101 male, 99 female) who met inclusion criteria. Eighty-seven patients underwent hip reconstruction, 62 spinal fusion, and 51 both hip and spine surgery asynchronously. Median (interquartile range) age at the time of surgery was significantly older for spinal fusion compared with hip surgery [13.1 (4.9) vs. 8.1 (5.7) y, P <0.0001]. Length of stay was significantly longer after PSF, with a median of 6 (4) days compared with 2 (1) days after hip surgery ( P <0.0001). Both maximum and average daily pain scores were similar following hip and spine surgery, with the exception that average pain scores for hip surgery were slightly higher on postoperative day 1, hip=1.73 vs. spine=1.0 ( P <0.0001). The amount of opioids used, expressed as morphine milligram equivalents (MME)/kg were similar in the hip and spine surgery groups; however, it was significantly lower in the hip surgery group on postoperative day 0, hip=0.06 versus spine=0.17 ( P <0.0001). For the 51 patients who underwent both hip and spine surgery, the amount of opioids used mirrored that for the entire group (similar MME/kg, though only statistically significantly less on POD 0 and 3), and pain scores were not significantly different between the 2 groups except in 2 circumstances. The 2 exceptions in these 51 patients both demonstrated lower pain scores in patients after hip surgery, including lower maximum pain scores on POD 1 ( P =0.041), and lower average pain scores on POD3 ( P =0.043). This is the largest series to date comparing postoperative pain in children with CP after hip and spine surgery, including 51 of 200 patients who underwent both types of surgery. The results of this study demonstrate that hip surgery is not more painful than spine surgery in children with CP, and conflict with the traditional belief that hip surgery is more painful. This is important information for health care providers when counseling patients and families regarding these surgeries in children with CP. Level 3.

ID: 336992 Peripheral Nerve Stimulation for Chronic Low Back Pain Following Lumbar Fusion: A Case Report

ID: 336992 Peripheral Nerve Stimulation for Chronic Low Back Pain Following Lumbar Fusion: A Case Report

Association Between Median Household Income and Perioperative Outcomes of Lumbar Spinal Fusion: An Analysis of the National Inpatient Sample (2009–2020)

Relationships between low socioeconomic status and surgical outcomes are well established for certain procedures. However, scant literature has focused on relationships between median household income and lumbar fusion outcomes. Patients who underwent fusion procedures between January 1, 2009 and December 31, 2020 were identified from the National Inpatient Sample database. They were categorized into 4 quartiles, from lowest to highest, based on median household incomes in respective zip codes. We applied univariable and multivariable linear and logistic regression models to analyze perioperative data according to income quartiles. We included 2,826,396 patients. In multivariable regression, patients in the 3 lowest income quartiles exhibited higher rates of in-hospital cardiac events perioperatively, with odds ratios (ORs) of 1.19 (95% confidence interval [CI]1.13-1.26, P < 0.001), 1.10 (95% CI 1.05-1.16, P<0.001), and 1.06 (95% CI 1.01-1.12, P= 0.011) for the first, second, and third quartiles, respectively. Patients in the lowest income (first) quartile had a higher occurrence of perioperative urinary complications (OR=1.07, 95% CI 1.03-1.12, P= 0.001), systemic infectious complications (OR=1.17, 95% CI 1.04-1.32, P= 0.006), neurological deficit (OR=1.17, 95% CI 1.06-1.30, P= 0.002), and wound infections (OR=1.22, 95% CI 1.12-1.34, P < 0.001). Those in the 3 lowest income quartiles were less likely to experience respiratory, gastrointestinal, and venous thrombotic complications (P < 0.05). The lowest income quartile had protective associations for dural tears (OR 0.93, 95% CI 0.89-0.99, P= 0.038) and postprocedure anemia across all 3 lower quartiles, with OR<1 and P < 0.001. Reduced household income significantly affected perioperative outcomes after lumbar fusion and should be taken into consideration during the perioperative period.

Management of Chronic Sacroiliac Joint Pain; Conservative versus Minimally Invasive Intervention versus Sacroiliac Joint Fusion; A Systematic Review

Abstract Background Chronic sacroiliac joint (SIJ) pain poses a significant clinical challenge, and the choice between conservative management and minimally invasive interventions or SIJ fusion is an ongoing debate. This systematic review and meta- analysis aimed to compare the effectiveness and safety of SIJ fusion versus conservative treatment versus minimally invasive interventions in patients with SIJ pain of degenerative origin or following lumbar fusion. Methods A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted using a predefined search strategy. The search process adhered to the PRISMA guidelines and utilized Cochrane's systematic review methods. Eligible studies were identified through a two-step screening process, and data were extracted for analysis, including visual analog scale (VAS) scores, Oswestry Disability Index (ODI), Short Form-36 (SF-36) scores, and recurrence rates of low back pain. Risk of bias was assessed using Cochrane's risk of bias tool for randomized clinical trials and the ROBINS-1 tool for non-randomized clinical trials. Results Sixteen studies met the inclusion criteria, and a detailed analysis of subgroups and overall outcomes was conducted. The results showed that VAS scores at baseline favored the conservative treatment, while VAS score improvements at 3 months were more prominent in the fusion procedure. At 9 months or more, both minimal intervention and fusion procedures demonstrated significant improvements. Regarding ODI, fusion procedures were associated with higher baseline scores, but significant improvements were observed at various time points. In contrast, the conservative treatment showed significant ODI improvements at 3 months. The SF-36 scores varied, with minimal intervention appearing more favorable for SF-36 PCS and MCS after 12 months. Conclusion The choice between SIJ fusion and conservative treatment should be tailored to the specific outcome of interest. Fusion procedures, especially for VAS scores and ODI at various time points, offer benefits, while conservative treatment is effective for early ODI improvements. For long-term functional and pain outcomes, both minimal intervention and fusion procedures demonstrate efficacy, with a slight advantage for the fusion procedure. Ultimately, treatment decisions should consider individual patient needs and desired outcomes. Further research is needed to refine treatment recommendations and enhance patient outcomes.