Lumbar Spinal Fusion In Patients Research Articles

Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial.

The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown. In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score. Secondary outcomes included the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, Zurich Claudication Questionnaire (ZCQ), Short Form (SF)-12, radiographic parameters, surgical variables, and complications. A total of 321 adult patients were randomized in a 2:1 fashion, with 219 patients assigned to undergo facet arthroplasty and 102 patients assigned to undergo fusion. Of these, 113 patients (51.6%) in the arthroplasty group and 47 (46.1%) in the fusion group who had either reached 24 months of postoperative follow-up or were deemed early clinical failures were included in the primary outcome analysis. The arthroplasty group had a higher proportion of patients who achieved composite clinical success than did the fusion group (73.5% versus 25.5%; p < 0.001), equating to a between-group difference of 47.9% (95% confidence interval, 33.0% to 62.8%). The arthroplasty group outperformed the fusion group in most patient-reported outcome measures (including the ODI, VAS back pain, and all ZCQ component scores) at 24 months postoperatively. There were no significant differences between groups in surgical variables or complications, except that the fusion group had a higher rate of developing symptomatic adjacent segment degeneration. Among patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis, lumbar facet arthroplasty was associated with a higher rate of composite clinical success than fusion was at 24 months postoperatively. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The Charlson Comorbidity Index and depression are associated with satisfaction after short-segment lumbar fusion in patients 75 years and older.

BackgroundThe rate and volume of lumbar spinal fusion (LSF) surgery performed for patients aged 75 years and older increased in recent years. The purposes of our study were to identify factors associated with postoperative dissatisfaction and evaluate the predictive value of comprehensive geriatric assessment (CGA) for dissatisfaction at 2 years after elective short-segment (one- or two- level) LSF in patients aged 75 and older.MethodsThis was a retrospective study using a prospectively collected database of consecutive patients (aged 75 and older) who underwent elective short-segment transforaminal lumbar interbody fusion surgery for degenerative diseases from June 2018 to May 2020. Preoperative CGA consisting six domains was performed for each patient 1 day before the operative day. Univariate and multivariate analyses were performed to identify factors that predict for dissatisfaction with surgical treatment. The primary outcome was patient satisfaction with LSF surgery, as measured by the North American Spine Society (NASS) satisfaction scale. Secondary outcomes included postoperative complications, the length of stay, visual analog scale (VAS), and Oswestry Disability Index.ResultsA total of 211 patients were available for a follow-up at 2 years and included in our final study cohort with a mean age of 80.0 years. A total of 175 patients (82.9%) were included in the satisfied group, and 36 patients (17.1%) were included in the not dissatisfied group. In the dissatisfied group, there was a higher incidence of postoperative complications (30.6% vs. 14.3%, p = 0.024) and greater VAS scores for lower back (4.3 ± 1.9 vs. 1.3 ± 1.4, p = 0.001) and leg (3.9 ± 2.1 vs. 0.9 ± 1.3, p = 0.001). Multivariate regression analysis revealed that patients with greater CCI score [odd ratio (OR) 2.56, 95% CI, 1.12–5.76; p = 0.030 for CCI 1 or 2 and OR 6.20, 95% CI, 1.20–28.69; p = 0.024], and depression (OR 3.34, 95% CI, 1.26–9.20; p = 0.016) were more likely to be dissatisfied compared with patients with the CCI score of 0 and without depression.ConclusionsSatisfaction after LSF in older patients (aged 75 and older) was similar to that of previously reported younger patients. Preoperative depression and higher CCI scores were independent risk factors for postoperative dissatisfaction two years after LSF surgery. These results help inform decision-making when considering LSF surgery for patients aged 75 and older.

Bone Metabolism in the Healing Process of Lumbar Interbody Fusion: Temporal Changes of Bone Turnover Markers.

Prospective longitudinal study. The aim of this study was to evaluate temporal changes of bone turnover markers (BTMs) after lumbar spinal fusion in patients without osteoporosis. Radiological studies are the standard method to monitor bony fusion, but they do not allow a timely assessment of bone healing. BTMs react rapidly to changes in bone metabolism during fusion process and could be an additional tool to monitor this process. A total of 78 nonosteoporosis patients who had undergone one- or two-level transforaminal lumbar interbody fusion were included. Fusion status was assessed using computed tomography sagittal and coronal images. Serum levels of bone-specific alkaline phosphatase (BAP), procollagen type 1 amino-terminal propeptide (P1NP), and osteocalcin (OC) were measured to assess bone formation, and tartrate-resistant acid phosphatase 5b (TRACP-5b) was measured to assess bone resorption. Serum samples were obtained before surgery and at 1, 2, 4, 8, 13, 26, 39, and 52 weeks after surgery. A solid fusion was achieved in 71 of 78 patients (91%), and seven patients resulted in pseudarthrosis. In the fusion group, the level of all BTMs once decreased at 1 postoperative week. Then, BAP and P1NP reached a peak at 4 weeks after surgery, and TRACP-5b and OC peaked at 8 weeks. Thereafter, the level of P1NP and TRACP-5b gradually got closer to the baseline over a year, and BAP kept high until 52 postoperative weeks. In the pseudarthrosis group, peak level of BTMs was significantly higher and the increased level of BAP and P1NP was kept until 52 weeks. The present study demonstrated dynamics of BTMs after lumbar spinal fusion in patients without osteoporosis. These normal population data contribute as a baseline to evaluate the effect of osteogenic agents on bone metabolism after spinal fusion.Level of Evidence: 2.

Cognitive Behavioral Therapy (CBT) After Lumbar Spinal Fusion in Patients With High Pain Catastrophizing

Cognitive Behavioral Therapy (CBT) After Lumbar Spinal Fusion in Patients With High Pain Catastrophizing

Thursday, September 27, 2018 1:05 PM–2:05 PM Lumbar Spine Surgery: What You Need to Know: 115. Matched cohort analysis of elective lumbar spinal fusion in patients with and without Parkinson disease

BACKGROUND CONTEXT Parkinson disease is a common neurodegenerative condition associated with significant morbidity and mortality. Parkinson disease patients often develop spinal conditions, and are known to have high complication rates following surgery; however, a matched cohort analysis controlling for comorbidity and age has not previously been performed. PURPOSE The purpose of this study was to evaluate the outcomes of lumbar fusion surgery in patients with Parkinson disease utilizing a large, publicly available, national database. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was evaluated for the years 2000-2012. Lumbar spinal fusions were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes. ICD-9 CM procedure codes were used to identify patients with Parkinson's disease. Patients were excluded if they received surgical treatment for traumatic injury. OUTCOME MEASURES The matched cohort was analyzed to determine the association of Parkinson disease with in-hospital complication rate, length of stay, and cost of hospitalization. METHODS Parkinson patients were matched 1:3 with non-Parkinson control patients for age, sex, Charlson Comorbidity Index and year of admission using a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between Parkinson's disease and surgical outcomes in the matched cohort. Adjusted odds ratios and 95% confidence intervals were calculated for surgical outcomes. Statistical analyses were performed utilizing SAS statistical software v.9.4 (SAS Institute, Inc. Cary, NC). Statistical significance was set at p RESULTS The study examined 231,351 elective lumbar fusion patients of which 1,332 had comorbid Parkinson disease. Before matching, elective lumbar fusion patients with Parkinson disease were significantly older and more male (p CONCLUSIONS The prevalence of Parkinson disease in lumbar fusion patients increased over time from 2000 to 2012. This matched cohort analysis demonstrated significant increases in length and cost of hospitalization for lumbar spinal fusion in patients with Parkinson disease. However, the complication rate in Parkinson patients was not significantly increased when compared with matched controls. Although inpatient complication rates were not significantly higher in this study, performing elective spinal fusion in Parkinson disease patients should be approached with caution as instrumentation failure and spinal deformity may develop postoperatively. This is the first matched cohort analysis indicating that lumbar spinal fusion can be safely considered in patients with Parkinson's disease. This study uses a much larger sample size than previous case series. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Matched Cohort Analysis of Elective Lumbar Spinal Fusion in Patients With and Without Parkinson's Disease: In-hospital Complications, Length of Stay, and Hospital Charges.

Study Design:Retrospective cohort.Objectives:Parkinson’s disease (PD) is a neurodegenerative condition associated with significant morbidity and mortality. PD patients often develop spinal conditions and are known to have high complication rates following surgery. This study evaluated the outcomes of lumbar fusion surgery in patients with PD using a large, public, national database.Methods:The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was used to identify elective lumbar spinal fusion patients with and without PD for the years 2000 to 2012. PD patients were matched with non-PD controls for comorbidity and age using propensity score matching. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort.Results:A total of 231 351 elective lumbar fusion patients were examined, of which 1332 had PD. Before matching, elective lumbar fusion patients with PD were significantly older (P < .001) and more likely male (P < .001) compared with non-PD patients. In the matched cohort, PD was associated with increased length of stay (6.91 vs 5.78 days) (P < .001) and total hospital charges ($129 212.40 vs $110 324.40) (P < .001). There was no significant difference in overall in-hospital complication rate between PD patients and matched non-PD patients (22.3% vs 21.4%) (P = .524).Conclusions:Analysis demonstrated significant increases in length and cost of hospitalization for elective lumbar spinal fusion in patients with PD. However, inpatient complication rates in PD patients were not significantly increased. As a growing number of PD patients undergo elective spine surgery, further studies are needed to optimize operative planning. Further study is needed to assess the long-term outcomes of lumbar spinal fusion in PD.

Effect of zoledronic acid on lumbar spinal fusion in osteoporotic patients.

To investigate the effect of zoledronic acid (ZA) on lumbar spinal fusion in patients with osteoporosis. This retrospective study includes 94 osteoporotic patients suffering from lumbar degenerative diseases or lumbar fracture who underwent lumbar spinal fusion in our institution from January 2013 to August 2014. They were divided into ZA group and control group according to whether the patient received ZA infusion or not. The patients in ZA group were given 5mg intravenous ZA at the 3rd-5th days after operation. All patients took daily oral supplement of 600mg calcium carbonate and 800IU vitamin D during the follow-up after operation. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) scores were recorded preoperatively and post-operatively to evaluate the clinic outcomes; the spinal fusion was assessed by X-ray or CT Scan. 64 patients finished the final follow-up, including 30 patients in ZA group and 34 patients in control group. No significant difference was observed in gender, age, and preoperative BMI VAS, ODI, and SF-36 scores between the two groups (P>0.05). The post-operative VAS and ODI scores decreased rapidly at 3 and 6months, but rose back slightly at 12 and 24months in both groups. On the contrary, post-operative SF-36 scores increased rapidly at 3 and 6months, while fell back slightly at 12 and 24months, with a statistically significant difference between the two groups at 12months, but not at 3 and 6month post-operation. The spinal fusion rate in ZA group was 90% at 6months, 92% at 12months, while it was 75% at 6months, 92.86% at 12months in control group, significantly different between the two groups at 12months, but not at 6months. In the whole follow-up period, adjacent vertebral compressing fracture occurred in five patients in control group, none in ZA group. No pedicle screw loosening was observed in ZA group, with six in control group. Zoledronic acid accelerates spinal fusion, shortens the time of fusion without changing fusion rate, and also decreases the risk of adjacent vertebral compressing fracture and the rate of pedicle screw loosening, resulting in the improvement of clinical outcomes and quality of life.

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusionfor patients with degenerative disc disease (DDD) and refractory chronic axiallow back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes -as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI)- were evaluated pre-operatively and at 6weeks, 3 months, 6months, and 1year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (includingbone scan/99mTc scintigraphyincreased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification)which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3months and continuing up to 1year of follow-up. In conclusion, LUFOS has been devised as anew practical and surgically oriented grading system based on simple keyparameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axialLBP.

Lumbar Spinal Fusion: Indications, Surgical Techniques and Post-Operative Management. A Survey among Spine Surgeons in the Netherlands

Study design: Cross sectional study Objective: Spinal fusion is commonly used for treatment of degenerative disc disorders. However, there is no consensus among spinal surgeons on operative technique, the type of implant being used and postoperative care. With the growing importance of Evidence Based Medicine, the demand for clinical guidelines is increasing. The aim of this study was to provide an overview of the current practice regarding lumbar spinal fusion among spinal surgeons in the Netherlands. The findings of this enquiry may help to create guidelines. Methods: An online 30-question survey was sent to all members of the DSS (orthopedic surgeons and neurosurgeons), focusing on operative techniques, implants and post-operative care after spinal fusion in patients with symptomatic degenerative conditions of the lumbar spine. Results: The response rate was 66%. The bilateral PLIF technique with 2 cages was preferred by most surgeons. Neurosurgeons used a PEEK cage more often, whereas orthopedic surgeons preferred a titanium cage. There was no consensus on assessment of outcome of fusion and post-operative care. Conclusions: There is little consensus among spine surgeons in the Netherlands regarding perioperative management, type of instrumentation and implants, operation technique, and postoperative management in lumbar spinal fusion in patients with symptomatic degenerative disc disorders, which underlines a growing demand for uniform guidelines.

The Effect of Electrical Stimulation on Lumbar Spinal Fusion in Older Patients: A Randomized, Controlled, Multi-Center Trial

Randomized, controlled, multi-center trial. To investigate the effect of direct current (DC) electrical stimulation on fusion rates after lumbar spinal fusion in patients older than 60 years. Older patients have increased complication rates after spinal fusion surgery. Treatments which have the possibility of enhancing functional outcome and fusion rates without lengthening the procedure could prove beneficial. DC-stimulation of spinal fusion has proven effective in increasing fusion rates in younger and "high risk" patients, but little information exist on the effect in older patients. A randomized clinical trial comprising 5 orthopedic centers. The study included a total of 107 patients randomized to uninstrumented posterolateral lumbar spinal fusion with or without DC-stimulation. Fusion rate was assessed at 2 year follow-up using thin slice CT. Functional outcome was assessed using Dallas Pain Questionnaire and Low Back Pain Rating Scale pain index. RESULTS.: Available follow-up after 2 years was 89% (84 of 95 patients). Fusion rates were surprisingly low. DC-stimulation had no effect on fusion rate: 35% versus 36% in controls. Other factors associated with low fusion rates were female gender (32% vs. 42% in males, P = 0.050) and smoking (21% vs. 42% in nonsmokers, P = 0.079). Patients who achieved a solid fusion as determined by CT had superior functional outcome and pain scores at their latest follow-up. Thin slice CT revealed very high nonunion rates after uninstrumented spinal fusion in older patients. DC-stimulation was not effective in increasing fusion rates in this patient population. The achievement of a solid fusion was associated with superior functional outcome.

The Effect of Electrical Stimulation on Lumbar Spinal Fusion in Older Patients: A Randomized, Controlled, Multi-Center Trial

Randomized, controlled, multi-center trial. To investigate the effect of direct current (DC) electrical stimulation on functional and clinical outcome after lumbar spinal fusion in patients older than 60 years. Older patients have increased complication rates after spinal fusion surgery. Treatments which have the possibility of enhancing functional outcome and fusion rates without lengthening the procedure could prove beneficial. DC-stimulation of spinal fusion has proven effective in increasing fusion rates in younger and "high risk" patients, but functional outcome measures have not been reported. A randomized, clinical trial comprising 5 orthopedic centers. The study included a total of 107 patients randomized to uninstrumented posterolateral lumbar spinal fusion with or without DC-stimulation. Functional outcome was assessed using Dallas Pain Questionnaire, SF-36, Low Back Pain Rating Scale pain index, and walking distance. Follow-up after 1 year was 95/107 (89%). DC-stimulated patients had significant better outcome in 3 of 4 categories in the Dallas Pain Questionnaire, better SF-36 scores (not significantly), but no difference in pain scores were observed. Median walking distance at latest follow-up was better in the stimulated group (not significant). Walking distance was significantly associated with functional outcome. There was no difference in any of the functional outcome scores between patients who experienced a perioperative complication and those without complications. The achievement of a good functional outcome was heavily dependent on the obtained walking distance. DC-stimulated patients tended to have better functional outcome as compared to controls. No negative effects of perioperative complications could be observed on the short-term functional outcome.