Patients Undergoing Lumbar Spine Surgery Research Articles

Hemodynamic changes in the prone position according to fluid loading after anaesthesia induction in patients undergoing lumbar spine surgery: a randomized, assessor-blind, prospective study

Introduction A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes. Patients and methods This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated. Results Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2–3 time points for SVV and PPV. Other outcomes did not differ between the two groups. Conclusion Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position. Trial number KCT0008294 (date of registration: 16 March 2023)

Predicting Multi-dimensional Surgical Outcomes with Multi-modal Mobile Sensing

Pre-operative prediction of post-surgical recovery for patients is vital for clinical decision-making and personalized treatments, especially with lumbar spine surgery, where patients exhibit highly heterogeneous outcomes. Existing predictive tools mainly rely on traditional Patient-Reported Outcome Measures (PROMs), which fail to capture the long-term dynamics of patient conditions before the surgery. Moreover, existing studies focus on predicting a single surgical outcome. However, recovery from spine surgery is multi-dimensional, including multiple distinctive but interrelated outcomes, such as pain interference, physical function, and quality of recovery. In recent years, the emergence of smartphones and wearable devices has presented new opportunities to capture longitudinal and dynamic information regarding patients' conditions outside the hospital. This paper proposes a novel machine learning approach, Multi-Modal Multi-Task Learning (M3TL), using smartphones and wristbands to predict multiple surgical outcomes after lumbar spine surgeries. We formulate the prediction of pain interference, physical function, and quality of recovery as a multi-task learning (MTL) problem. We leverage multi-modal data to capture the static and dynamic characteristics of patients, including (1) traditional features from PROMs and Electronic Health Records (EHR), (2) Ecological Momentary Assessment (EMA) collected from smartphones, and (3) sensing data from wristbands. Moreover, we introduce new features derived from the correlation of EMA and wearable features measured within the same time frame, effectively enhancing predictive performance by capturing the interdependencies between the two data modalities. Our model interpretation uncovers the complementary nature of the different data modalities and their distinctive contributions toward multiple surgical outcomes. Furthermore, through individualized decision analysis, our model identifies personal high risk factors to aid clinical decision making and approach personalized treatments. In a clinical study involving 122 patients undergoing lumbar spine surgery, our M3TL model outperforms a diverse set of baseline methods in predictive performance, demonstrating the value of integrating multi-modal data and learning from multiple surgical outcomes. This work contributes to advancing personalized peri-operative care with accurate pre-operative predictions of multi-dimensional outcomes.

Construct validation of the Japanese Core Outcome Measures Index and the impact of diseases on patient-reported outcome measures in preoperative patients with lumbar spinal stenosis and disk herniation: a single-center observational study.

The primary objective was to validate the construct validity of the Japanese Core Outcome Measures Index (COMI) in preoperative patients aged 60years or older undergoing lumbar spine surgery for lumbar spinal stenosis (LSS) and lumbar disk herniation (LDH). Additionally, as a secondary aim, we explored the impact of these diseases on quality of life (QOL). The analysis included 199 preoperative patients aged 60 and above who were scheduled for lumbar spine surgery. To assess QOL, Japanese versions of the COMI, Oswestry Disability Index (ODI), EuroQol-5 Dimension-3 Level (EQ-5D-3L), and SF-12v2 were employed. The study assessed the validity of the COMI and compared demographic and clinical characteristics between the LSS (147 cases) and LDH (52 cases) groups. It used multivariate covariance analysis (MANCOVA) to examine the impact of diseases (LSS and LDH) on each patient-reported outcome measure while considering covariates. Compared to the LSS group, the LDH group showed more difficulty with the COMI summary score (LSS/LDH [mean]: 6.9/8.1, p < 0.001), ODI score (46.8/57.4, p < 0.001), and EQ-5D utility (0.53/0.43, p < 0.001). The LDH group also reported more difficulties in the COMI-function, COMI-symptom-specific well-being, COMI-disability, ODI-personal care, ODI-social life, and SF-12v2-bodily pain subscales. MANCOVA demonstrated that these results were not influenced by covariates such as gender and medical history. This study highlights the distinct impact of LSS and LDH on preoperative QOL in older patients undergoing lumbar spinal surgery. Tailored interventions are essential to address the specific challenges posed by these conditions and improve patient-centered outcomes and postoperative recovery.

The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine.

Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery. Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling. From 731 eligible patients, 547 (61.0 ± 12.5years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3months' FU in men (β = 0.36) and 12months' FU in men and women (both β = 0.20) (all p < 0.001). The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.

Post-operative Patient Portal Messaging is Associated With Return to the Emergency Department After Lumbar Spine Surgery.

Retrospective study. To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) post-operatively and emergency department (ED) visits within 90 days of surgery. Secure patient messaging through electronic patient portals has grown over recent years. Despite its frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery. This study was approved by our Institutional Review Board. Inclusion criteria were adults who underwent single-stage lumbar spine surgery between January 2016-June 2023. Patients with incomplete information, multi-stage surgeries, and those who died within 90 days of surgery were excluded. Patient sociodemographic, surgical, hospital readmission, and patient-provider engagement data were collected. A total of 13,135 patients were included. A total of 1,711 patients (13%) had a post-operative ED visit, and 4,791 patients (36%) used the patient portal to send a message after surgery. Sending a post-operative patient message after undergoing lumbar spine surgery was associated with an increased likelihood of having an ED visit that does not lead to readmission (1.29 (1.10-1.53), P = 0.002). Patients with high school degrees were more likely to have an ED visit without readmission (1.33 (1.08-1.65), P = 0.008). Patients at a higher risk of presenting to the ED post-operatively should be identified and may benefit from additional counseling and access to the care team virtually to limit unnecessary healthcare utilization. Focusing on patients who reach out via EPP messaging post-operatively may be a good target patient group to address first. Future research is needed to investigate the possible health literacy and other socioeconomic barriers affecting these patients so that appropriate, more cost-effective resources can be utilized to avoid clinically unnecessary and costly ED visits.

289 Mental Health Comorbidities in Workers Compensation Patients and the Effect on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery

INTRODUCTION: Outcomes after lumbar spine surgery in workers’ compensation (WC) patients have been reported to be worse than the general population. Anxiety and depression are modifiable risk factors that also adversely affect outcomes after lumbar spine surgery. METHODS: We queried a nationwide, prospective surgical outcomes registry (AANS-QOD) for all patients undergoing lumbar spine surgery at over 200 hospital systems from 2012 to 2021. Perioperative safety, facility utilization, one-year patient-reported outcomes (pain, disability, and quality-of-life), and return to work (RTW) were measured as a function of WC and mental health comorbidity status. RESULTS: A total of 27,525 patients (1018 WC, 26,507 non-WC) undergoing 1-4 level lumbar spine surgery (14,914 laminectomy, 12,611 fusion) were reviewed. WC patients were younger, healthier (lower ASA grade), more likely to be minorities, less educated, more likely to smoke, and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups. WC patients had worse outcomes for all measures and lower rates of RTW compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety or depression (n = 107) continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety or depression (n = 107). CONCLUSIONS: Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spinal pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

Evaluation of Analgesic Nociceptive Index in intraoperative and postoperative pain management in general anesthesia applied with two different methods

Aim: Effectiveness of analgesic nociceptive index (ANI) monitoring in predicting both intraoperative and postoperative early pain in neurosurgery patients undergoing lumbar spinal surgery. The patients were administered general anesthesia using different anesthesia management techniques.Method: The study included a total of 60 patients with American Society of Anesthesiologist (ASA) I-III. The patients were randomly divided into two groups of 30 each using the closed envelope method. Group T received total intravenous anesthesia (TIVA) with remifentanil-propofol, while Group D with desflurane-remifentanil. Non-invasive ANI monitoring was applied to patients undergoing lumbar spinal surgery, and ANI, heart rate, systolic/diastolic arterial pressure values were recorded before and after induction, skin incision, major muscle incision, laminectomy, right-left fasciectomy, screw fixation, after extubation and during the postoperative period. Post-operative heart rate, ANI value, mean arterial pressure values, and visual analog scale (VAS) values were measured.Results: No statistically significant difference was found in terms of the demographic data of the patients. According to the groups, no statistically significant difference was found between the ANI and VAS measurements of the cases at the postoperative 5th minute (P=0.261), postop 10th minute (P=0.379), postop 15th minute (P=0.673), postop 30th minute (P=0.784) and postop 60 minute (p =0.750).Conclusions: In our study on lumbar spine surgery, we could not detect any significant relationship between ANI monitoring and VAS values in the early postoperative period. There was no difference in ANI and VAS with either anaesthetic technique. In light of the results of our study, we believe that more studies are needed on the use of ANI monitoring in the early postoperative period.

The Relationship of Spinal Anesthesia Dosing Based on Thecal Sac Area to Anesthetic Failure in Lumbar Surgery.

Greater thecal sac volumes are associated with an increased risk of spinal anesthesia (SA) failure. The thecal sac cross-sectional area accurately predicts thecal sac volume. The thecal sac area may be used to adjust the dose and prevent anesthetic failure. We aim to assess the rate of SA failure in a prospective cohort of lumbar surgery patients who receive an individualized dose of bupivacaine based on preoperative measurement of their thecal sac area. A total of 80 patients prospectively received lumbar spine surgery under SA at a single academic center (2022-2023). Before surgery, the cross-sectional area of the thecal sac was measured at the planned level of SA injection using T2-weighted MRI. Patients with an area <175 mm2, equal to or between 175 and 225 mm2, and >225 mm2 received an SA injection of 15, 20, or 25 mg of 0.5% isobaric bupivacaine, respectively. Instances of anesthetic failure and adverse outcomes were noted. Incidence of SA failure was compared with a retrospectively obtained control cohort of 250 patients (2019-2022) who received the standard 15 mg of bupivacaine. No patients in the individualized dose cohort experienced failure of SA compared with 14 patients (5.6%) who experienced failure in the control cohort (P = .0259). The average thecal sac area was 187.49 mm2, and a total 28 patients received 15 mg of bupivacaine, 42 patients received 20 mg of bupivacaine, and 10 patients received 25 mg of bupivacaine. None of the patients experienced any adverse outcomes associated with SA. Patients in the individualized dose cohort and control cohort were comparable and had a similar distribution of lumbar procedures and comorbidities. Adjusting the dose of SA according to thecal sac area significantly reduces the rate of SA failure in patients undergoing lumbar spine surgery.

Comparison of sleep improvement in patients undergoing lumbar spine decompression.

Degenerative spine conditions affect many people each year. These conditions have been shown to negatively impact pain, function, and patient quality of life (QOL), which often require surgical intervention. It is understood that sleep plays an important role in all of these factors. However, the relationship between sleep disruption and lumbar surgery is not well understood. The objective of this study was to use a large database to understand the relationship between sleep quality and lumbar spine surgery outcomes. The surgical database of the authors' institute was used to identify all patients undergoing lumbar spine surgery for degenerative spine disease from January 1, 2012, through December 31, 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were collected, and only patients with both pre- and postoperative scores were included. Additional measures related to disability, pain, and depression were also obtained. Chart review was performed to collect patient demographics, health risk factors, and information related to sleep disturbances such as sleep medication usage and prior sleep condition diagnosis. The study had 674 patients who met the criteria. At 3, 6, and 12 months postoperatively, there was a significant decrease in sleep disruption scores (i.e., sleep improvement), although these decreases were not greater than the minimal clinically important difference (MCID). When stratified based on preoperative sleep quality, patients with poor preoperative scores (PROMIS sleep disruption > 63.04) showed a significant decrease in sleep disruption by 8.17 at 3 months, 7.99 at 6 months, and 7.21 at 12 months. All of these decreases were greater than the sleep disruption MCID of 6.5. Multivariate analysis showed high preoperative sleep disruption and improvement in PROMIS physical health were most associated with decreased postoperative sleep disruption at all postoperative time points. In patients with degenerative spine conditions, lumbar spine surgery offers improvement in sleep disruption for all patients. Those with poor preoperative sleep quality are more likely to see clinical improvement in their sleep disruption.

A study on the 10-year trend of surgeries performed for lumbar disc herniation and comparative analysis of prescribed opioid analgesics and hospitalization duration: 2010–2019 HIRA NPS Data

BackgroundThis study, utilizing the claims data from the Health Insurance Review and Assessment Service of Korea, aimed to examine the 10-year (2010–2019) trends in various types of lumbar spine surgeries performed on patients diagnosed with lumbar herniated intervertebral disc (HIVD), and the current status of opioid prescriptions, as well as the duration of postoperative hospital stays based on the type of surgery performed.MethodThis retrospective cross-sectional study examined patients with one or more national health insurance claims carrying a primary or secondary diagnosis of HIVD (ICD-10 codes: M511, M518, M519) over a 10-year period (2010–2019). From the patients undergoing lumbar spine surgery, we selected those who did not require reoperation within 30 days following the initial lumbar surgery. Our final study sample comprised patients who underwent only one type of surgery.ResultsAmong the patients diagnosed with HIVD and subsequently undergoing lumbar surgery between 2010 and 2019, a slight downward trend was observed in those undergoing open discectomy (OD); however, OD persistently accounted for the highest proportion over the 10 years. Percutaneous endoscopic lumbar discectomy (PELD) demonstrated a consistent upward trend from 2016 to 2018. When inspecting trends, we noted a consistent escalation over the decade in the postoperative opioid prescription rates of strong opioids (50.7% in 2010 to 77.8% in 2019) and tramadol (50.9% in 2010 to 76.8% in 2019). Analyzing these trends by surgery type, spinal fusion exhibited a slightly higher rate of opioid prescriptions than other lumbar surgeries. Regarding the length of postoperative hospital stays, patients undergoing PELD recorded the shortest stay (7.04 ± 6.78 days), while spinal fusion necessitated the longest (20.14 ± 12.18 days).ConclusionThis study analyzed the trends in types of lumbar spine surgeries, opioid analgesic prescriptions, and length of hospital stays over 10 years (2010–2019) among patients with HIVD in Korea. Our data and findings provide valuable evidence that may prove beneficial for clinicians and researchers involved in HIVD-related practices.

Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery

BackgroundThe objective of this study was to explore the internal consistency and factor structure of the Oswestry Disability Index among patients undergoing spinal surgery. The sample consisted of 1,515 patients who underwent lumbar spinal surgery at a university hospital between 2018 and 2021.MethodsThe patients responded to the Oswestry Disability Index within 2 months before surgery. Cronbach’s alpha was used to assess the internal consistency. The factor structure was evaluated using exploratory and confirmatory factor analyses.ResultsThe average age of 1,515 patients was 58.5 (SD 15.8) years and 53% were women. The mean ODI score was 43.4% (SD 17.4%). Of the patients, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots. The internal consistency of the Oswestry Disability Index was found to be good, with an alpha of 0.87 (95% CL 0.86 to 0.88). Exploratory factor analysis resulted in unidimensional structure. Item loadings on this retained factor were moderate to substantial for all 10 items. One-factor confirmatory factor analysis model demonstrated an acceptable fit. The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling”, “personal care”, and “social life”. The lowest correlations were observed for the item “standing”.ConclusionsThe Oswestry Disability Index is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling,” “social life,” “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.Trial registrationNot applicable.

Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial

BackgroundSevere pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery.MethodsA total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery.ResultsThe12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1–3) vs. 3 (2–4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed.ConclusionsBilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD.Trial registrationThe study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.

Correlation of Lumbar Spine Fat Thickness and Surgical Site Infection in Degenerative Lumbar Spine Surgery

Introduction: Surgical site infection (SSI) is a serious and common complication following any surgery. Patientsundergoing lumbar surgery have a higher risk for SSI. Therefore, it is essential to accurately identifythe risk factors of SSIs to prevent them. There is an insufficient number of studies internationally andonly one to our knowledge nationally that studied the correlation between lumbar fat thickness andSSI in patients undergoing lumbar spine surgery. Our aim was to identify the correlation betweenlumbar fat thickness and SSI and determine its predictive value compared to other risk factors inpredicting the incidence of SSI.&#x0D; Methods: This retrospective cohort study involved all patients aged 18 and above who underwent primary elective degenerative lumbar spine surgery in National Guard Health Affairs (NGHA) from 2016 to 2020 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All trauma and oncology cases, patients with previous spine surgery, non-instrumented cases, and emergency cases without preoperative radiological images were excluded. The pre-operative and post-operative measurements were assessed using the sagittal MRI images on the T1 view to measure the fat length of the lumbar spine from L2 to S1. Two observers evaluated the films, and the average measurement was documented for each level.&#x0D; Results: 151 patients were included in our study, four of whom developed SSI. When comparing the demographics of both groups, BMI was found to be a significant variable between both groups, with a P-value of 0.013. However, there was no significance regarding age, gender, DM, HTN, steroid use, and level of stay for each group. Furthermore, there was no significance in all vertebrae levels except for L4 fat thickness, which was significantly higher in the SSI group with a P value of 0.0264.&#x0D; Conclusion: Surgical site infection (SSI) is a serious and common complication following any surgical operation. Patients undergoing lumbar surgery have a higher risk for SSI. In this study, we concluded that an increased L4 fat thickness was a significant predictor of SSI.

Comparison of parameter types for the calibration of noninvasive continuous cardiac output monitoring of patients undergoing lumbar spinal surgery in the prone position.

Cardiac output (CO) decreases on reversing the patient's position to the prone position. Estimated continuous cardiac output (esCCO) systems can noninvasively and continuously monitor CO calibrated by patient information or transesophageal echocardiogram (TEE). To compare the accuracy, precision, and trending ability of two calibration methods of CO estimation in patients in prone position. The CO estimates calibrated by TEE (esT) and patient information (esP) of 26 participants were included. CO was collected at four time points. The accuracy and precision of agreement were evaluated using the Bland-Altman method. A four-quadrant plot was used for trending ability analysis. The bias between esP and TEE and between esT and TEE was 0.2594 L/min (95% limits of agreement (LoA): -1.8374 L/min to 2.3562 L/min) and 0.0337 L/min (95% LoA: -0.7381 L/min to 0.8055 L/min), respectively. A strong correlation was found between ΔesP and ΔTEE (p< 0.001, CCC = 0.700) and between ΔesT and ΔTEE (p< 0.001, CCC = 0.794). The concordance rates between ΔesP and ΔTEE and between ΔesT and ΔTEE were 91.9% and 97.1%, respectively. Despite limited accuracy and precision, esP showed acceptable trending ability. The trending ability of esCCO calibrated by the reference TEE value was comparable with that of TEE.

Pulsed Electromagnetic Field Stimulation in Lumbar Spine Fusion for Patients With Risk Factors for Pseudarthrosis.

Lumbar spinal fusion surgeries are increasing steadily due to an aging and ever-growing population. Patients undergoing lumbar spinal fusion surgery may present with risk factors that contribute to complications, pseudarthrosis, prolonged pain, and reduced quality of life. Pulsed electromagnetic field (PEMF) stimulation represents an adjunct noninvasive treatment intervention that has been shown to improve successful fusion and patient outcomes following spinal surgery. A prospective, multicenter study investigated PEMF as an adjunct therapy to lumbar spinal fusion procedures in patients at risk for pseudarthrosis. Patients with at least 1 of the following risk factors were enrolled: prior failed fusion, multilevel fusion, nicotine use, osteoporosis, or diabetes. Fusion status was determined by radiographic imaging, and patient-reported outcomes were also evaluated. A total of 142 patients were included in the analysis. Fusion status was assessed at 12 months follow-up where 88.0% (n = 125/142) of patients demonstrated successful fusion. Fusion success for patients with 1, 2+, or 3+ risk factors was 88.5%, 87.5%, and 82.3%, respectively. Significant improvements in patient-reported outcomes using the Short Form 36, EuroQol 5 Dimension (EQ-5D) survey, Oswestry Disability Index, and visual analog scale for back and leg pain were also observed compared with baseline scores (P < 0.001). A favorable safety profile was observed. PEMF treatment showed a positive benefit-risk profile throughout the 6-month required use period. The addition of PEMF as an adjunct treatment in patients undergoing lumbar spinal surgery provided a high rate of successful fusion with significant improvements in pain, function, and quality of life, despite having risk factors for pseudarthrosis. PEMF represents a useful tool for adjunct treatment in patients who have undergone lumbar spinal surgery. Treatment with PEMF may result in improved fusion and patient-reported outcomes, regardless of risk factors. NCT03176303.

Predictive factors for treatment success of epidural steroid injections in patients with lumbar spinal surgery.

The efficacy of epidural steroid injections (ESIs) in the treatment of radicular pain in patients undergoing lumbar spinal surgery is still unclear. The aim of this study was to investigate the factors affecting the success of ESIs in the treatment of ongoing radicular pain in patients undergoing lumbar spinal surgery. This study was designed as a single-center, retrospective study, and was conducted at a Pain Management Center of a tertiary care center. A total of 260 patients with failed back surgery syndrome who received fluoroscopy-guided lumbar ESI were included. Treatment success was defined as ≥50% reduction in the numeric rating scale score at the one-month follow-up. The patients were divided into the treatment success and the treatment failure groups. The presence of spinal instrumentation was significantly lower in the treatment success group (p=0.045). Symptom duration and the numeric rating scale score at 1 hour were significantly lower in the treatment success group (p<0.05). The use of triamcinolone acetonide in the treatment success group was found to be significantly higher than in the treatment failure group (p=0.027). The short duration of symptoms and the absence of instrumentation seem to be prognostic factors that positively affect the success of ESI treatment in operated patients. A ≥50% pain reduction in the first hour after the procedure is a valuable indicator that treatment success can be achieved in the short term. Finally, the steroid type can also affect the treatment results.

Utility of transcranial motor-evoked potential changes in predicting postoperative deficit in lumbar decompression and fusion surgery: a systematic review and meta-analysis.

The primary aim of this study was to evaluate whether TcMEP alarms can predict the occurrence of postoperative neurological deficit in patients undergoing lumbar spine surgery. The secondary aim was to determine whether the various types of TcMEP alarms including transient and persistent changes portend varying degrees of injury risk. This was a systematic review and meta-analysis of the literature from PubMed, Web of Science, and Embase regarding outcomes of transcranial motor-evoked potential (TcMEP) monitoring during lumbar decompression and fusion surgery. The sensitivity, specificity, and diagnostic odds ratio (DOR) of TcMEP alarms for predicting postoperative deficit were calculated and presented with forest plots and a summary receiver operating characteristic curve. Eight studies were included, consisting of 4923 patients. The incidence of postoperative neurological deficit was 0.73% (36/4923). The incidence of deficits in patients with significant TcMEP changes was 11.79% (27/229), while the incidence in those without changes was 0.19% (9/4694). All TcMEP alarms had a pooled sensitivity and specificity of 63 and 95% with a DOR of 34.92 (95% CI 7.95-153.42). Transient and persistent changes had sensitivities of 29% and 47%, specificities of 96% and 98%, and DORs of 8.04 and 66.06, respectively. TcMEP monitoring has high specificity but low sensitivity for predicting postoperative neurological deficit in lumbar decompression and fusion surgery. Patients who awoke with new postoperative deficits were 35 times more likely to have experienced TcMEP changes intraoperatively, with persistent changes indicating higher risk of deficit than transient changes. Diagnostic Systematic Review.

Erector Spinae Plane Block for Post-Operative Analgesia in Lumbar Spine Surgeries

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. Lumbar spine surgeries are usually associated with acute postoperative pain and restricted mobility. 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. Aim of the Work The present study was designed to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing lumbar spine surgeries 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 70 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Results The main finding in this study was that ultrasound guided ESPB at level of lumbar process provides a good analgesic effect in patients undergoing lumbar spine surgery as following: 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, decease 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 lumbar spine surgeries, without any associated adverse effects or complications.

Regional analgesia techniques for lumbar spine surgery: A frequentist network meta-analysis.

Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing lumbar spine surgery. Traditionally, wound infiltration (WI) with local anesthetics has been widely used by surgeons. Recently, other regional analgesia techniques, such as the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block, are being used for multimodal analgesia. We aimed to determine the relative efficacy of these using a network meta-analysis (NMA). We searched PubMed, EMBASE, the Cochrane Controlled Library, and Google Scholar databases to identify all randomized controlled trials (RCT) that compared the analgesic efficacy of the following interventions: erector spinae plane block (ESPB), thoracolumbar interfascial plane (TLIP) block, wound infiltration (WI) technique and controls. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery while pain score, estimated postoperatively at three different time periods, was the secondary objective. We included 34 RCTs with data from 2365 patients. TLIP showed the greatest reduction in opioid consumption compared to controls (mean difference (MD) =-15.0mg; 95% CI, -18.8 to -11.2). In pain scores TLIP had the greatest effect during all time periods compared to controls (MD =-1.9 in early, -1.4 in middle, -0.9 in late). The injection level of ESPB was different in each study. When only surgical site injection of ESPB was included in the NMA, there was no difference compared with TLIP (MD =1.0mg; 95% CI, -3.6 to 5.6). TLIP showed the greatest analgesic efficacy after lumbar spine surgery, in terms of postoperative opioid consumption and pain scores, while ESPB and WI are also alternative analgesic options for these surgeries. However, further studies are needed to determine the optimal method of providing regional analgesia after lumbar spine surgery.

ID: 206245 Relationship Between Prior Spine Surgeries and Outcomes Following Spinal Cord Stimulation: A Pooled Analysis

Lumbar spine surgery is a common procedure for treating disabling spine-related pain. Ten to 40% of patients undergoing lumbar spine surgery experience persistent pain following the operation. Spinal cord stimulation (SCS) is a treatment indicated for failed back surgery syndrome (FBSS) with or without radiculopathy. The purpose of this review is to retrospectively determine the average pain relief felt from SCS implants after one or more failed lumbar spine surgeries.