Open Anterior Fusion Research Articles

Characteristics and Outcomes of Patients Treated with Cervical Spine Fusion at High Volume Hospitals

High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion and compare characteristics and outcomes for patients treated at HV centers versus lower volume centers. The National Inpatient Sample database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology. HV was defined as case-loads greater than 2 standard deviations above the mean. Patient characteristics, procedures, and outcomes were compared. Of 3895 hospitals performing cervical spine fusion for degenerative pathology, 28 (0.76%) were HV. The Mid-Atlantic and West South Central regions had the highest number of HV hospitals. HV hospitals were more likely to perform open anterior fusion surgeries (P<0.01). Patients treated at HV hospitals were less likely to have severe symptomatology or comorbidities (P<0.01 for all). When controlling for severity and demographics on multivariate analysis, HV centers had higher odds of length of stay ≤1day, favorable discharge, and decreased total charges. Patients who underwent cervical spine fusion surgery at HV hospitals were less complex and had increased odds of length of stay ≤1, favorable discharge, and total charges in the lower 25th percentile than patients treated at non-HV hospitals. Physician comfort, patient selection, institutional infrastructure, and geographic characteristics likely play a role.

Arthroscopic versus open ankle fusion

Background Open ankle arthrodesis has been the standard operative treatment for any case of advanced osteoarthritis ankle, but the arthroscopic technique is gained popularity. Patients methods This study was conducted retrospectively reviewing surgeries undertaken between January 2010 and June 2012 for ankles with osteoarthritis. The authors performed 42 ankle arthrodesis procedures on 42 patients. A total of 20 patients were included in group A (arthroscopic ankle fusion), and the other 22 patients were in group B (open anterior ankle fusion). Patients of each group were assessed using preoperative Ankle Osteoarthritis Scale (AOS) score; both the pain and disability components were used to calculate the total score. Results In group A, all the cases were united, with the average time for union being 12.8±1.19 weeks. Of 20 ankles, 65% showed signs of clinical and radiological union by 12 weeks. The early results showed major decrease in AOS from 116±8.6 preoperatively to 19.4±2.3 postoperatively. This shows that the arthroscopic fusion was able to decrease the score by an average of 97.7±10.2 points. Long-term follow-up was 71.8±8.6 months and showed that the early postoperative results did not change significantly: 55% of patients still had excellent outcome, and four patients (20%) develop subtalar osteoarthritis. In group B, 21 cases (>95%) were united, with an average time to union of 13.3±5.6 weeks. The early results showed major decrease in AOS from 114±7.24 preoperatively to 26.68±6.95 postoperatively. This shows that the open anterior fusion was able to decrease the score by an average of 88.2±7.2 points. Long-term follow up was 83.5±12 months and showed that the early postoperative results changed significantly, where nine patients (40.9%) still had excellent outcome, and nine patients (40.9%) developed subtalar osteoarthritis and four of them needed further subtalar fusion. Conclusion This was a comparative study that involved two groups with two techniques of ankle fusion, showing early and late results. There was no significant difference between both the groups regarding early results, but long-term follow-up clarifies the advantages of arthroscopic fusion technique.

Thoracic and Lumbar Fractures: Mini-Open Anterior Fusion in 138 Patients

Background: Several surgical procedures have been recommended for the management of thoracic and lumbar fractures. Nowadays Mini- Open Anterior Fusion is reported to be a safe and effective alternative treatment for various spinal pathologies. Aim: The aim of this study is to report the outcome of 138 cases who underwent mini open thoraco-lumbar surgery for thoracic and lumbar fractures. Material and Methods: We performed a non-randomized retrospective analysis of the clinical outcome of 138 patients with 140 fractures who underwent mini open thoraco-lumbotomy surgery, between 2011 and 2016. Follow up periods were 6th weeks, 3rd and 6th months and also 1 year postoperatively. All the patients were operated with mini open thoraco/lumbotomy system (Syn-Frame). All of our patients with fractures, undervent posterior pedicle screw fixation prior to the anterior fusion just after the posterior fusion or a couple of days later (mean: 4.2; 2 to 7 days), depending on the general condition of patients. Thorax drainage was placed to all thoracotomy patients (63% to 87%). Results: Fractures of 13 cases were due to tumor metastasis, and the rest of them were due to acute fractures, spondylodiscitis. 87 cases had thoracic (T6-T12) and 51 cases had lumbar (L1-L5) fractures. Discussion: Several methods are being used in order to achieve safe, and minimaly invasive approach in cases with thoracolumbar pathologies. The complication rates of this procedure are similar to endoscopy assisted thoracotomy. Syn-Frame System allows the opportunity to perform even 2-3 levels corpectomy and stabilization through a 5 cm skin incision. It is possible to insert 4 or more retractors from all angles to form an area just over the level operation level, without dealing with aorta, lung, urethra or heart. Conclusion: We can estimate that this approach is safe, minimally invasive and effective besides reducing the pain and morbidity of conventional methods.

Minimally Invasive versus Open Sacroiliac Joint Fusion: A Comparison of Outcomes in Propensity Matched Cohorts

The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known.

Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. We compared estimated blood loss (EBL), surgical time, length of hospital stay (LOS), and Oswestry Disability Index (ODI) between patients undergoing MIS and open sacroiliac joint fusion. We retrospectively studied 63 patients (open: 36; MIS: 27) who underwent sacroiliac joint fusion with minimum 1-year followup at our institution from 2006 to 2011. Of those, 10 in the open group had incomplete records. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score, adjusting for age, sex, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. We reviewed patient medical records to obtain EBL, length of surgery, LOS, and pre- and postoperative ODI scores. Mean followup was 13 months (range, 11-33 months) in the open group and 15 months (range, 12-26 months) in the MIS group. Patients in the open group had a higher mean EBL (681 mL versus 41 mL, p < 0.001). Mean surgical time and LOS were shorter in the MIS group than in the open group (68 minutes versus 128 minutes and 3.3 days versus 2 days, p < 0.001 for both). With the numbers available, mean postoperative ODI scores were not different between groups (47% versus 54%, p = 0.272). EBL, surgery time, and LOS favored the MIS sacroiliac fusion group. With the numbers available, ODI scores were similar between groups, though the study size was relatively small and it is possible that the study was underpowered on this end point. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients' sacroiliac joints successfully fused, so longer followup and critical evaluation of outcomes scores over time are called for. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

The Effect of Surgical Approaches on Pulmonary Function in Adolescent Idiopathic Scoliosis

Retrospective study. To evaluate the effects of 4 surgical approaches for adolescent idiopathic scoliosis on pulmonary function and document their trend across a 2-year period. Understanding the effects of surgical approaches on pulmonary function is critical in the treatment of adolescent idiopathic scoliosis. Depending on the surgical approach, studies have demonstrated improvement, decline, or no effect on pulmonary function. Sixty-one patients were evaluated for vital capacity (VC) and peak flow (PF) before and following surgery at 1, 3, 6, 12, and 24 months. Patients were separated into the following groups: group 1-posterior fusion only, group 2-posterior fusion with thoracoplasty, group 3-thoracoscopic anterior fusion, group 4-open anterior thoracolumbar fusion. Between groups, no difference was found in age, preoperative curve magnitude, percent curve correction or baseline VC and PF. At 1-month postoperatively, group 3 had lower VC than group 1 (P<0.01). After 1 month, no difference was seen between groups. Compared with before surgery, group 2 demonstrated a significant decline in VC and PF at 1 month and returned to baseline at 3 months (P<0.01). Group 3 had a significant decline in VC and PF at 1, 3, and 6 months whereas group 4 had a decline in VC at 1 month (P<0.01). Scoliosis approaches that violate the chest wall demonstrate a significant decline in postoperative pulmonary function. Documented return of pulmonary function did not occur until 3 months for posterior fusion with thoracoplasty, 3 months for open anterior fusion and 1 year for video-assisted thoracoscopic surgery.