Lumbar Spine Surgery Research Articles

Ultrasound Guided Erector Spinae Block Using Bupivacaine – Magnesium Sulphate versus Bupivacaine – Dexmedetomidine for Postoperative Analgesia in Lumbar Spine Surgeries

Abstract Purpose Lumbar spine surgeries are associated with significant postoperative pain. Erector Spinae Plain Block (ESPB) is a new ultra-sound guided block technique for such surgeries . We aimed to explore the analgesic effect of adding dexmedetomidine and magnesium sulfate as adjuvants to bupivacaine in ESP. Patients and Methods Fifty two patients scheduled for lumbar spine surgery were randomly allocated into two groups to receive an ESP block., A total volume of 25 ml, [10 mL 0.5% bupivacaine diluted in normal saline (NS) and 2 mg/kg MgSO4 in group (MG group) and 10 mL 0.5% bupivacaine in NS with 2 μg/kg dexmedetomidine in group (DEX group)] were injected. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 12 hours. Results The demographic data including age, gender, height, weight and BMI showed no difference between both groups, also, ASA classification and duration of surgeries done showed no difference between the studied groups (P > 0.05). There were no recorded complications in both groups (P > 0.05). There was no significant difference among both groups regarding basal, and follow up period at 15 min values of heart rate, and basal value of mean arterial pressure (P > 0.05), but for the intraoperative hemodynamic parameters including MAP and HR, both parameters decreased significantly in the group which received dexmedetomidine in comparison to the other group except follow up values at 180 and 210 min, as no significant differences were recorded among both groups (P > 0.05). Regarding postoperative pain, the visual analogue score (VAS) was used to record it postoperatively every 2 hours while we found a statistically significant difference regarding the VAS from 4 to 6 hours postoperatively as P < 0.005, but, we found no difference regarding the postoperative total consumption of nalbuphine (P < 0.005) . As for patient satisfaction in the studied groups, an anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient). Dexmedetomidine group was associated with a significant increase in satisfaction compared to MG group (P < 0.05). Conclusion Magnesium sulphate and dexmedetomidine seem to be both effective adjuvants to bupivacaine in ESP blocks for postoperative analgesia in patients undergoing lumbar spine surgeries, with slightly better analgesia provided by dexmedetomidine.

Comparison of Volume-Controlled Ventilation (VCV) Mode and Pressure-Controlled Ventilation (PCV) Mode in Patients Undergoing Lumbar Spine Surgery in the Prone Position

Abstract Background The prone position is commonly required to enable surgical access during lumbar spine surgery. When a patient moves into the prone position, inferior vena cava obstruction causes reduced venous return and increase thoracic pressure results in reduced left ventricular compliance, leading to a decreased cardiac index (CI). Aim of the Work The aim of this study, we will compare the effects of the VCV and PCV on peak airway pressure (P peak), ETCO2 as a primary outcome ABG, SPO2, and hemodynamics as MAP, HR and as a secondary outcome in the prone position. Patients and Methods This prospective, single blinded study included 60 patients who assigned randomly into two equal groups: group A: patients on volume-controlled ventilation mode VCV and group B: patients on pressure-controlled ventilation mode PCV. Results Baseline characteristics (age, sex, BMI, ASA physical status, duration of anesthesia and surgery) were insignificantly different between both groups. Heart rate and MAP at supine and prone positions at all time measurements were insignificantly different between both groups. P peak and SpO2 at supine and prone positions at all time measurements were insignificantly different between both groups. Respiratory rate and ETCO2 at supine and prone positions at all time measurements were insignificantly different between both groups. Conclusion No significant difference between two modes of ventilation VCV and PCV in patients undergoing lumbar spine surgery in the prone position as regard P peak, ETCO2, SPO2, and hemodynamics.

Effect of Intra-Operative Erector Spinae Plane Block on Post-Operative Consumption of Opioids after Video-Assisted Thoracoscopic Surgeries (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Although VATS is less painful than an open thoracotomy, patients may still feel severe pain and restricted mobility during the first few postoperative hours. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Objective to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing VATS for postoperative analgesia. Patients and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 30 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Patients were randomly divided into two equal groups, 15 each, according to the inclusion and exclusion criteria. Group A (n = 15): Received fentanyl 1-2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation in addition 40 ml bupivacaine 0.25% (20ml on each side) as a single level bilateral injection for ESPB. Group B (n = 15) (the controlled group): Received only fentanyl 1- 2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing VATS also reduced the total amount of postoperative morphine consumption in comparison to controlled group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake. Conclusion Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after VATS, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB slightly decreased the rate of PONV. This might be because the use of ESP might have decreased the use of intraoperative opioids.

Discrepancy between global- and disease-specific outcome measures following lumbar spine surgery.

The aim of this study was to assess the correlation between patient-perceived changes in health and commonly utilized patient-reported outcome measures (PROMs) in lumbar spine surgery. This was a retrospective review of prospectively collected data on consecutive patients who underwent lumbar microdiscectomy, lumbar decompression, or lumbar fusion at a single academic institution from 2017 to 2023. Correlation between the global rating of change (GRC) questionnaire, a 5-item Likert scale (much better, slightly better, about the same, slightly worse, and much worse), and PROMs (Oswestry Disability Index, visual analog scale for back and leg pain, 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary, and PROMIS physical function) was assessed using Spearman's rank correlation coefficients. A total of 1871 patients (397 microdiscectomies, 965 decompressions, and 509 fusions) were included. A majority of patients in each group rated their lumbar condition as much better at each postoperative time point compared with preoperatively and reported improved health status at each postoperative time point compared with the previous follow-up visit. Statistically significant but weak to moderate correlations were found between GRC and change in PROM scores from the preoperative time point. Correlation between GRC and change in PROM scores from the prior visit showed some statistically significant correlations, but the strengths ranged from very weak to weak. A majority of patients undergoing lumbar microdiscectomy, decompression, or fusion endorsed notable improvements in health status in the early postoperative period and continued to improve at late follow-up. However, commonly used PROMs demonstrated very weak to moderate correlations with patient-perceived changes in overall lumbar spine-related health status as determined by GRC. Therefore, currently used PROMs may not be as sensitive at detecting these changes or may not be adequately reflecting changes in health conditions that are meaningful to patients undergoing lumbar spine surgery.

Comparison of Intrathecal Morphine Versus Erector Spinae Plane Block for Perioperative Analgesia in Patients Undergoing Lumbar Spine Surgery: A Randomized Control Trial.

Lumbar spine surgery is associated with a significant degree of moderate-to-severe perioperative pain which can be alleviated by using different pain-relieving modalities; of these, erector spinae plane block and intrathecal morphine have promise. To compare the analgesic efficacy between intrathecal morphine (ITM) versus erector spinae plane block (ESPB) for perioperative analgesia in patients undergoing lumbar spine surgery. A total of 74 patients aged between 20 and 65 years of either sex were posted for elective lumbar spine surgery. Patients were divided into two groups: Group A patients received 0.3 mg intrathecal morphine andGroup B received bilateral erector spinae plane block at L3 level by using 30 mL of 0.5% ropivacaine before starting the surgery for perioperative analgesia. In the perioperative period, pain was assessed by hemodynamic parameters (heart rate and mean arterial pressure), numeric rating scale (NRS), and patient satisfaction score. Result: The difference in heart rate and mean arterial pressure was found to be statistically significant between groups at three, six, 12, and 24 hours (p<0.05). The patients who required rescue analgesia in Group A and Group B were 23 (62.2%) and 37 (100%) patients in the first 24 hours. The rate of complication was higher in Group A than in Group B (45% vs 5.4%). The patient satisfaction score was found to be better in Group A than in Group B. Intrathecal morphineprovides more substantial and extended analgesia up to 48 hours postoperatively as compared to erector spinae plane block.

The effect of opioid-free anesthesia on enhanced recovery after lumbar spine surgeries

The effect of opioid-free anesthesia on enhanced recovery after lumbar spine surgeries

The efficacy of lumbar erector spinae plane block for postoperative analgesia management in patients undergoing lumbar unilateral bi-portal endoscopic surgery: a prospective randomized controlled trial

BackgroundThe efficacy and reliability of erector spinae plane block (ESPB) in posterior open lumbar spine surgery has been demonstrated; however, few randomized controlled trials of lumbar ESPB (L-ESPB) in lumbar unilateral bi-portal endoscopic (UBE) surgery have been reported.MethodsA total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores.ResultsCompared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference − 280 mcg, 95% confidence interval [CI] − 360 to − 200, p < 0.001, power = 100%); significantly reduced fentanyl consumption at 24 h postoperatively (estimated median difference − 80mcg, 95%[CI] − 128 to − 32, p = 0.001, power = 90%); and significantly enhanced the QoR-15 score at 24 h postoperatively (estimated median difference 11, 95%[CI] 8 to 14, p < 0.001, power = 100%). Compared to the control group, the ESPB group enhanced the resting numeric rating scale (NRS) score up to 8 h postoperatively, and the active movement NRS score up to 4 h postoperatively. The incidence of postoperative nausea and vomiting (PONV) (p = 0.015, power = 70%), abdominal distension (p = 0.024, power = 64%), and muscular calf vein thrombosis (MCVT) (p = 0.033, power = 58%) was lower in the ESPB group than in the control group. Moreover, the occurrence of L-ESPB related adverse reactions was not found herein.ConclusionUS-guided L-ESPB reduces intraoperative and 24 h postoperative opioid consumption and improves patients' QoR-15 scores at 24 h postoperatively. L-ESPB can be safely and effectively utilized in lumbar UBE surgery.Trial registrationChinese Clinical Trial Registry, ChiCTR2200061908, date of registration: 10/07/2022. Registry URL.

Radiological Evaluation of Lumbar Endplate Dimensions in the Indian Population and Their Correlation With Cage Placement/Length in Diverse Lumbar Fusion Techniques.

Background Lumbar fusion techniques are vital for treating various spinal conditions by promoting vertebral fusion to alleviate pain and restore stability. Given the anatomical uniqueness of the Indian skeletal structure, this study evaluates the radiological dimensions of lumbar endplates in the Indian population and their correlation with the placement and length of interbody cages used in various lumbar fusion techniques such as oblique lateral lumbar interbody fusion (OLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF). This study aimed to conduct radiological measurements of lumbar endplates in the Indian population and correlate them with cage placement and length in lumbar fusion techniques. Methods This prospective study was conducted at the orthopaedic ward of a tertiary care center in Western Maharashtra, India. Healthy individuals (aged >18 years, either gender) selected with a 95% confidence level using Philip Core Integrity software (Amsterdam, Netherlands) were included in the study. We excluded thosewith a history of low back pain, previous lumbar spine surgeries, fractures, tuberculosis, tumors, deformities, degenerative diseases, or lesions affecting the lumbar spine.Quantitative measurements such as oblique and sagittal diameters, apophyseal ring widths, and interbody cage lengths were calculated using multiplanar reformatting with specific imaging parameters. Results A total of 150 individuals with an average age of 39.83 ± 14.17 years, ranging from 20 to 65 years. Among the study population, 68 were males and 82 were females. Among the male study population, oblique parameters such as Angle AOB and Mid-OD (oblique diameter) show considerable variability, with Angle AOB ranging from 51.43 ± 2.40 mm (L2 inferior) to 31.59 ± 4.25 mm (L5 inferior) and Mid-OD ranging from 41.59 ± 2.59 mm (L3 superior) to 34.38 ± 2.26 mm (S1 superior). Side-sagittal dimensions vary from 32.11 ± 2.50 mm (S1 superior) to 36.48 ±3.26 mm (L3 superior), emphasizing the need for tailored surgical planning. In contrast, females in the study population exhibit distinct anatomical profiles, with Angle AOB ranging from 52.15 ± 2.43 mm (L2 inferior) to 20.45 ± 5.45 mm (S1 superior) and Mid-OD from 33.48 ± 2.15 mm (L3 inferior) to 42.45 ± 2.59 mm (L3 superior). These findings underscore gender-specific anatomical differences crucial for individualized clinical evaluation and treatment strategies. Conclusion This study comprehensively analyzes oblique, side-sagittal, transverse, and midsagittal anatomic parameters across various vertebral levels in men and women, highlighting significant anatomical variations crucial for clinical assessments and surgical interventions.

Effectiveness of Electroacupuncture for Managing Urinary Retention Post Lumbar Spine Surgery: a retrospective single-cohort study.

Post-operative urinary retention (POUR) is a frequent complication following surgical procedures, characterized by an acute inability to void, leading to additional complications and extended hospitalization. Acupuncture has been shown to be effective in facilitating spontaneous urination and alleviating anxiety in patients experiencing poor urination. The present study aims to evaluate the effectiveness of electroacupuncture in the management of POUR in patients who have undergone lumbar spine surgery. This retrospective study conducted at the National Hospital of Acupuncture in Vietnam and reviewed the medical records of patients over 18 years old who underwent lumbar spine surgery and were diagnosed with POUR between January to December 2019. Electroacupuncture was administered at five specific acupuncture points Qugu (CV2), Zhongji (CV3), Zhibian (BL54), Pangguanshu (BL28), and Kunlun (BL60). This study monitored key parameters related to the effectiveness of the acupuncture treatment, including the number of acupuncture treatment sessions required until a patient was successfully treated was recorded, with a maximum of three acupuncture treatment sessions per patient, the time elapsed until urination following the treatment (minutes), and urinary bladder volume before and after treatment (mL). The study demonstrated a 93.3% success rate in treating POUR with electroacupuncture. A significant reduction in post-void residual volume was noted, and patients could void within 30 minutes post-treatment. No significant differences in treatment effectiveness were observed across difference genders and age groups. Electroacupuncture proved to be a highly effective treatment for POUR in patients post-lumbar spine surgery, with a rapid response time and substantial reduction in PVR. However, the retrospective nature of the study and single-center focus limit its generalizability. Future research incorporating randomized controlled trials or multi-center observational studies are recommended to validate these findings and explore the potential of acupuncture in POUR management on a broader scale.

Effect of standardized acupoint massage on abdominal distension in patients after lumbar spine surgery

Effect of standardized acupoint massage on abdominal distension in patients after lumbar spine surgery

Leveraging machine learning to develop a postoperative predictive model for postoperative urinary retention following lumbar spine surgery.

Postoperative urinary retention (POUR) is the inability to urinate after a surgical procedure despite having a full bladder. It is a common complication following lumbar spine surgery which has been extensively linked to increased patient morbidity and hospital costs. This study hopes to development and validate a predictive model for POUR following lumbar spine surgery using patient demographics, surgical and anesthesia variables. This is a retrospective observational cohort study of 903 patients who underwent lumbar spine surgery over the period of June 2017 to June 2019 in a tertiary academic medical center. Four hundred and nineteen variables were collected including patient demographics, ICD-10 codes, and intraoperative factors. Least absolute shrinkage and selection operation (LASSO) regression and logistic regression models were compared. A decision tree model was fitted to the optimal model to classify each patient's risk of developing POUR as high, intermediate, or low risk. Predictive performance of POUR was assessed by area under the receiver operating characteristic curve (AUC-ROC). 903 patients were included with average age 60 ± 15 years, body mass index of 30.5 ± 6.4 kg/m2, 476 (53%) male, 785 (87%) white, 446 (49%) involving fusions, with average 2.1 ± 2.0 levels. The incidence of POUR was 235 (26%) with 63 (7%) requiring indwelling catheter placement. A decision tree was constructed with an accuracy of 87.8%. We present a highly accurate and easy to implement decision tree model which predicts POUR following lumbar spine surgery using preoperative and intraoperative variables.

Postdischarge opioid use after lumbar spine surgery among older adults in Ontario: a population-based cohort study.

Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs. We conducted a retrospective population-based cohort study using Ontario administrative data from older adults undergoing spine surgery between 2006 and 2017. Data were analyzed from 90 days preoperatively to 1 year after hospital discharge, with last postoperative opioid prescriptions stratified into 90-day increments. We used multivariable ordinal logistic regression to identify predictors of long-term opioid use and generalized linear modelling to examine resource utilization and health care costs (2021 Canadian dollars). Of 15 109 patients included, 40.8% received preoperative opioid prescriptions. Preoperative opioid use strongly predicted prolonged postoperative use (odds ratio [OR] 4.47, 95% confidence interval [CI] 4.16-4.79), with 48.3% of patients who received preoperative opioids continuing to use opioids for longer than 9 months, relative to 12.7% of those without preoperative use. Several other risk factors for prolonged use were identified. Patients receiving long-term postoperative opioids incurred greater health care costs relative to those with opioids prescribed for fewer than 90 days (OR 1.49, 95% CI 1.44-1.54). Among older adults undergoing spine surgery, preoperative opioid use was a strong predictor of prolonged postoperative use, which was associated with increased health care costs. These results form an important baseline for future studies evaluating strategies to reduce opioid use targeting older surgical populations.

Prospective same day discharge instrumented lumbar spine surgery - a forty patient consecutive series.

Outpatient lumbar decompression surgeries have been successfully performed in France for over twenty years, earning acceptance. However, outpatient instrumented lumbar spine procedures and arthroplasties are less documented. This study aimed to evaluate the feasibility, efficiency, and safety of outpatient lumbar instrumented surgery. A prospective single-center study involving three experienced surgeons was conducted from September 2020 to September 2021, with a minimum six-month postoperative follow-up. Inclusion criteria comprised patients aged 18 to 75 eligible for same-day discharge, undergoing single-level lumbar spinal fusion or arthroplasty via anterior or posterior Wiltse approach. The primary endpoint was assessing the percentage of successful outpatient discharges (within twelve hours), with secondary endpoints including perioperative/postoperative complications and discharge pain prescriptions in terms of frequency and severity. Forty patients (mean age: 44 years; 16/24 male/female ratio) underwent surgery, including 18 lumbar arthroplasties, twelve ALIF, and ten TLIF procedures. The majority of surgeries were performed at L4-L5 (18 procedures) and L5-S1 levels (22 procedures). 95% (38/40) of patients were successfully discharged within twelve hours, with only two patients discharged the following day. No postoperative hematomas, serious adverse events, or revision surgeries were noted. 95% of patients were discharged successfully within twelve hours following outpatient lumbar fusion surgery, with a 100% patient satisfaction rate. Specific technical solutions were not necessary, and oral pain relief sufficed. Patient selection and education, including early pain management, played crucial roles in complication avoidance. This study underscores the safety of outpatient instrumented lumbar spine procedures, leading to cost reduction and expedited recovery.

Erector Spinae Plane Block Versus Thoracolumbar Interfascial Plane Block in Lumbar Spine Surgery: A Meta-Analysis of Randomized Controlled Trials.

Meta-analysis. To compare the effectiveness of postoperative pain control between erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block in lumbar spine surgery. PubMed, Embase, and MEDLINE electronic databases were searched for articles containing randomized controlled trials (RCTs) published between January 1900 and January 2024. We extracted the postoperative mean pain score, the first 24-h postoperative morphine consumption, and their standard deviation from the included studies. Meta-analysis was performed using the functions available in the metafor package in R software. We pooled continuous variables using an inverse variance method with a random-effects model and summarized them as standardized mean differences. Five RCTs that directly compared the ESPB and TLIP block in lumbar spine surgery were included, enrolling 432 participants randomly into the two groups with 216 participants in each group. The pooled analyses showed that there was no significant difference between the ESPB and TLIP groups in terms of lower pain scores during the early (1h) (standardized mean difference [SMD] -1.49, 95% confidence interval [CI], -3.10; 0.11), middle (12h) (SMD -3.12, 95% CI, -6.86; 0.61), and late (24h) (SMD -1.38, 95% CI, -3.01; 0.24) postoperative periods. There was also no significant difference in the first 24-h postoperative morphine equivalent consumption between the ESPB and TLIP groups (SMD -0.46mg, 95% CI -1.23; 0.31). No significant difference was observed between the ESPB and TLIP block in terms of postoperative pain control and 24-h morphine equivalent consumption for lumbar spine surgery.

Impact of sarcopenia on outcomes following lumbar spine surgery for degenerative disease: an updated systematic review and meta-analysis.

This study aimed to consolidate the evidence regarding the prognostic influence of sarcopenia in degenerative lumbar spine surgeries. A literature search of public databases was conducted up to Nov 15, 2023 using combinations of the key words "sarcopenia" and "lumbar spine surgery". Eligible studies were those that focused on adults undergoing decompression or fusion surgery for degenerative lumbar spine diseases, and compared the outcomes between patients with and without preoperative sarcopenia. Primary outcomes were change in ODI and back and leg pain VAS pain scores. Secondary outcomes were changes in Eq.5D, JOA, SFHS-p scores, and LOS. Ultimately, nine retrospective studies with a total of 993 patients were included. Sarcopenic patients exhibited significantly worse functional improvement as assessed by ODI compared to non-sarcopenic patients (pooled standardized mean difference [pSMD] = 0.53, 95% confidence interval [CI]: 0.17-0.90). Back pain (pSMD = 0.31, 95% CI:0.15-0.47) and leg pain (pSMD = 0.21, 95% CI:0.02 - 0.39) improvement were also less in sarcopenic patients. Non-sarcopenic patients had greater improvements in Eq.5D (pSMD = 0.25) and SFHS-p (pSMD = 0.39), and shorter LOS (pSMD = 0.62). As compared to patients without sarcopenia, those with sarcopenia undergoing lumbar spine surgery for degenerative diseases have lower improvements in functional ability, quality of life, physical health, pain relief and extended hospitalization compared to those without sarcopenia.

Is an Elevated Preoperative CRP Level a Predictive Factor for Wound Healing Disorders following Lumbar Spine Surgery?

A retrospective analysis was conducted on a cohort of 3019 patients who underwent lumbar spine surgery over a decade in our department. The study aimed to assess the predictors of wound healing disorders, focusing on laboratory values, particularly inflammatory parameters. Of the 3019 patients, 2.5% (N = 74) experienced deep or superficial wound healing disorders, showing the significant correlation between C-reactive protein (CRP) levels and these disorders (p = 0.004). A multivariate analysis identified several factors, including age, sex, hypertension, diabetes, cardiac comorbidity, surgical duration, dural injury, and blood loss, as being correlated with wound healing disorders. Demographic factors, pre-existing conditions, and perioperative variables play a role in the occurrence of adverse effects related to wound healing disorders. Elevated CRP levels serve as an indicator of increased infection risk, though they are not a definitive diagnostic tool for wound healing disorders.

Surgical treatment of refractory low back pain using implanted BurstDR spinal cord stimulation (SCS) in a cohort of patients without options for corrective surgery: Findings and results from the DISTINCT study, a prospective randomized multi-center-controlled trial

Background: Low back pain (LBP) is a highly prevalent, disabling condition affecting millions of people. Patients with an identifiable anatomic pain generator and resulting neuropathic lower extremity symptoms often undergo spine surgery, but many patients lack identifiable and/or surgically corrective pathology. Nonoperative treatment options often fail to provide sustained relief. Spinal cord stimulation (SCS) is sometimes used to treat these patients, but the lack of level 1 evidence limits its widespread use and insurance coverage. The DISTINCT RCT study evaluates the efficacy of passive recharge burst SCS compared to conventional medical treatment (CMM) in alleviating chronic, refractory axial low back pain. MethodsThis prospective, multicenter, randomized, study with an optional 6-month crossover involved patients who were not candidates for lumbar spine surgery. The primary and secondary endpoints evaluated improvements in low back pain intensity (NRS), back pain-related disability (ODI), pain catastrophizing (PCS), and healthcare utilization. Patients were randomized to SCS therapy or CMM at 30 US study sites. ResultsThe SCS arm reported a 85.3% NRS responder rate (≥ 50% reduction) compared to 6.2% (5/81) in the CMM arm. After the 6M primary endpoint, SCS patients elected to remain on assigned therapy and 66.2% (49/74) of CMM patients chose to trial SCS (crossover). At the 12M follow-up, SCS and crossover patients reported 78.6% and 71.4% NRS responder rates. Secondary outcomes indicated significant improvements in ODI, PCS, and reduced healthcare utilization. Six serious adverse events were reported and resolved without sequelae. ConclusionDISTINCT chronic low back pain patients with no indication for corrective surgery experienced a significant and sustained response to burst SCS therapy for up to 12 months. CMM patients who crossed over to the SCS arm reported profound improvements after 6 months. This data advocates for a timely consideration of SCS therapy in patients unresponsive to conservative therapy.

The effect of preemptive retrolaminar block on lumbar spinal decompression surgery

PurposeSpinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption.MethodsThe sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome.ResultsThere was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33–3.509)] and movement [2.40 (1.20–4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100–300); Group 2: 37.5 (0–200); p < 0.001].ConclusionPreemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption.Trial registration numberClinicalTrials.gov (No. NCT04209907).

Cost-Effectiveness and Clinical Outcomes of Lateral Lumbar Interbody Fusion With Tricalcium Phosphate and Iliac Bone Graft Compared With Posterior Lumbar Interbody Fusion With Local Bone Graft in Single-Level Lumbar Spinal Fusion Surgery in Thailand.

Nowadays, minimally invasive lateral lumbar interbody fusion (LLIF) is used to treat degenerative lumbar spine disease. Many studies have proven that LLIF results in less soft tissue destruction and rapid recovery compared with open posterior lumbar interbody fusion (PLIF). Our recent cost-utility study demonstrated that LLIF was not cost-effective according to the Thai willingness-to-pay threshold, primarily due to the utilization of an expensive bone substitute: bone morphogenetic protein 2. Therefore, this study was designed to use less expensive tricalcium phosphate combined with iliac bone graft (TCP + IBG) as a bone substitute and compare cost-utility analysis and clinical outcomes of PLIF in Thailand. All clinical and radiographic outcomes of patients who underwent single-level LLIF using TCP + IBG and PLIF were retrospectively collected. Preoperative and 2-year follow-up quality of life from EuroQol-5 Dimensions-5 Levels and health care cost were reviewed. A cost-utility analysis was conducted using a Markov model with a lifetime horizon and a societal perspective. All enrolled patients were categorized into an LLIF group (n = 30) and a PLIF group (n = 50). All radiographic results (lumbar lordosis, foraminal height, and disc height) were improved at 2 years of follow-up in both groups (P < 0.001); however, the LLIF group had a dramatic significant improvement in all radiographic parameters compared with the PLIF group (P < 0.05). The fusion rate for LLIF (83.3%) and PLIF (84%) was similar and had no statistical significance. All health-related quality of life (Oswestry Disability Index, utility, and EuroQol Visual Analog Scale) significantly improved compared with preoperative scores (P < 0.001), but there were no significant differences between the LLIF and PLIF groups (P > 0.05). The total lifetime cost of LLIF was less than that of PLIF (15,355 vs 16,500 USD). Compared with PLIF, LLIF was cost-effective according to the Thai willingness-to-pay threshold, with a net monetary benefit of 539.76 USD. LLIF with TCP + IBG demonstrated excellent radiographic and comparable clinical health-related outcomes compared with PLIF. In economic evaluation, the total lifetime cost was lower in LLIF with TCP + IBG than in PLIF. Furthermore, LLIF with TCP + IBG was cost-effective compared with PLIF according to the context of Thailand. LLIF with less expensive TCP + IBG as bone graft results in better clinical and radiographic outcomes, less lifetime cost, and cost-effectiveness compared with PLIF. This suggests that LLIF with TCP + IBG could be utilized in lower- and middle-income countries for treating patients with degenerative disc disease.

Comparison of perioperative outcomes in obese and non-obese patients subjected to open lumbar spine surgery

Comparison of perioperative outcomes in obese and non-obese patients subjected to open lumbar spine surgery