Surgery For Degenerative Spine Conditions Research Articles

P69. Older people living with degenerative spine disease and undergoing spine surgery: just trying to get back to a normal life

<h3>BACKGROUND CONTEXT</h3> Lumbar degenerative spine disease is a consequence of aging. Globally, 266 million people are diagnosed with this debilitating condition annually. As the population ages, the number of spinal surgeries to address the symptoms of this condition will increase. However little information is available about the experiences of older people living with degenerative spine disease and who undergo spine surgery. <h3>PURPOSE</h3> The purpose of this study was to investigate older peoples' understandings of living with and having surgery for degenerative spine disease and the process they engage in to try to get back to their normal life. <h3>STUDY DESIGN/SETTING</h3> A qualitative approach, grounded theory (GT), in a Midwestern quaternary care hospital. <h3>PATIENT SAMPLE</h3> Participants were = 65yrs of age, hospitalized following spine surgery for degenerative spine disease. <h3>OUTCOME MEASURES</h3> Interviews lasted from 30-60 minutes. Early interviews were open and non-directional, to obtain the meanings that participants assigned to having spine surgery for degenerative spine conditions. As analysis progressed, interviews became more focused to add category depth. <h3>METHODS</h3> A total of 28 interviews with 14 individuals who were recruited for 2 in-depth interviews at 2-time points: T1 during hospitalization and T2, 1-3 months post discharge. All 14 participants were interviewed at T1; 10 at T2-one month; 2 at T2- two months and 2 at T2-3 months postdischarge (N=28 interviews). Interviews lasted 30-60 minutes. All interviews were audio recorded and transcribed verbatim. Consistent with GT, purposive and theoretical sampling was used. Data analysis included open, axial, and selective coding and was conducted by an interdisciplinary team. <h3>RESULTS</h3> Based on analysis of the data, a conceptual model was developed which illustrates the phases older persons with degenerative spine disease go through in their trajectory of trying to get back to their normal life. Three key categories identified were (1) losing me (2) fixing me and (3) recovering me. Multiple dimensions within each category were identified. All participants described a prolonged process of losing who they were in terms of functional independence and being able to socialize. Fixing me consisted of having to prove the need for surgery and preparing for surgery. Recovering me involved constant monitoring for success and progress with rehabilitation. For most, recovering me was ongoing- none identified they had returned to their normal. Several conditions, including setbacks and delays, slowed participants recovery trajectory. Throughout this process, participants had to continually adjust their expectations of what was returning to normal. Additionally, participants described complications as ongoing symptoms of their degenerative spine disease after surgery, and a long, protracted course in trying to get back to normal life. <h3>CONCLUSIONS</h3> The conceptual model, based on real-world patient experiences, details how older people engage in living with and undergoing surgery for degenerative spine disease. Our model can serve as the foundation for developing interventions to guide patient education programs for preparing for surgery, improve transitions of care and develop patient-centered approaches for treating and managing older people with degenerative spine disease and spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Incidence and risk factors of spinal cord stimulation for persistent or recurrent pain after lumbar spine surgery: a population-based study

PurposeThis study aims to elucidate the incidence of and independent risk factors for spinal cord stimulator implantations for patients who underwent lumbar spine surgery.MethodsThe PERFormance, Effectiveness, and Cost of Treatment (PERFECT) episodes database, which was established for selected diseases and procedures in Finland, includes all patients who underwent lumbar spine surgery for degenerative spine conditions or spinal cord stimulation (SCS) in Finland from 1986 to 2018. The data on age, sex, hospital diagnoses, surgical procedures, and causes of death were imported from the Finnish national registers into the PERFECT database.ResultsBetween 1986 and 2018, 157,824 patients had their first lumbar spine procedure and for 1769 (1.1%) of them, a subsequent SCS procedure was observed during the follow-up. The cumulative incidence of SCS for persistent or recurrent pain after lumbar disk herniation, spinal stenosis, degenerative disk disease, and spondylolysis and spondylolisthesis surgery at 15 years was 1.2%, 1.0%, 2.7%, and 2.6% respectively. At 15 years, the cumulative incidence of SCS for persistent or recurrent pain after lumbar spine surgery after five or more lumbar spinal operations was 11.9%.ConclusionRepeated surgery was the most prominent significant risk factor for SCS for persistent or recurrent pain after lumbar spine surgery. The risk of SCS for persistent or recurrent pain after lumbar spine surgery increases significantly along with the number of lumbar spine procedures. When considering repeated lumbar spine surgery, careful evaluation of treatment options should take place to ensure good patient outcomes.

Psychological, mobility, and satisfaction variables mediate the relationship between baseline back pain intensity and long-term outcomes in individuals who underwent lumbar spine surgery

BackgroundIn patients who receive spine surgery, pain is relational to disability and quality of life, but exactly how this influence is mediated is not fully understood. Mediation analyses allow an understanding of a known relationship by exploring the underlying mechanism or processes by which one variable influences another. ObjectivesTo determine the mediating influence of psychological, mobility, and satisfaction variables on the relationship between preoperative back pain intensity and 12-month disability and quality of life in individuals who underwent lumbar spine surgery. DesignThis mediation analysis study used data from the Quality Outcomes Database (QOD) Lumbar Spine Surgical Registry. MethodsThere were included individuals who received lumbar spine surgery for degenerative spine conditions. The exposure variable was preoperative back pain intensity. Mediator variables were depression/anxiety, mobility, and satisfaction. Outcomes included disability and quality of life. Separate multiple mediator models were conducted using the Hayes PROCESS, Model 4 with bias-corrected bootstrapping (5000 samples) to predict disability and quality of life. Results26,130 individuals (n = 13,740 males, mean age 60.2 [SD = 13.8) were included. We observed a significant indirect effect through the mediators (anxiety/depression, mobility and satisfaction), for both disability (b = 0.31, 95%CI = 0.26, 0.35) and quality of life (b = −0.44, 95%CI = −0.48, −0.41). ConclusionOur study suggests that the relationship between preoperative back pain intensity (exposure) and long-term disability and quality of life (outcomes) is partially mediated by anxiety/depression, mobility, and patient satisfaction in individuals who received lumbar spine surgery.

Drivers of Prolonged Hospitalization Following Spine Surgery: A Game-Theory-Based Approach to Explaining Machine Learning Models.

Understanding the interactions between variables that predict prolonged hospital length of stay (LOS) following spine surgery can help uncover drivers of this risk in patients. This study utilized a novel game-theory-based approach to develop explainable machine learning models to understand such interactions in a large cohort of patients treated with spine surgery. Of 11,150 patients who underwent surgery for degenerative spine conditions at a single institution, 3,310 (29.7%) were characterized as having prolonged LOS. Machine learning models predicting LOS were built for each patient. Shapley additive explanation (SHAP) values were calculated for each patient model to quantify the importance of features and variable interaction effects. Models using features identified by SHAP values were highly predictive of prolonged LOS risk (mean C-statistic = 0.87). Feature importance analysis revealed that prolonged LOS risk is multifactorial. Non-elective admission produced elevated SHAP values, indicating a clear, strong risk of prolonged LOS. In contrast, intraoperative and sociodemographic factors displayed bidirectional influences on risk, suggesting potential protective effects with optimization of factors such as estimated blood loss, surgical duration, and comorbidity burden. Meticulous management of patients with high comorbidity burdens or Medicaid insurance who are admitted non-electively or spend clinically indicated time in the intensive care unit (ICU) during their hospitalization course may be warranted to reduce their risk of unanticipated prolonged LOS following spine surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

P25. Association of preoperative hemoglobin A1c and body mass index with wound infection rate in spinal surgery

BACKGROUND CONTEXT Diabetes mellitus and obesity are common comorbidities in patients undergoing surgery for degenerative spine conditions. The association of preoperative glycemic control with surgical outcomes and complications is well described for general and orthopedic surgery, but less clear in spinal surgery. PURPOSE To undertake a large retrospective database review to examine the relationship between documented pre-operative hemoglobin A1c as a measure of glycemic control, as well as BMI as a measure of obesity, and their influence of post-operative infectious complications in patients undergoing surgery for degenerative spinal conditions. STUDY DESIGN/SETTING Large retrospective database review via the Veterans Administration Corporate Data Warehouse, accessing the National VA Database using VA Informatics and Computing Infrastructure (VINCI). PATIENT SAMPLE All VA patients undergoing surgery for degenerative spine conditions from 2007 to 2016, queried from a national database using CPT codes. A total of 430,000 CPT codes were identified representing 191,320 unique procedures, of which 175,895 patients had sufficient records for including in our analysis. OUTCOME MEASURES Preoperative hemoglobin A1c, preoperative height and weight, age at the time of surgery; postoperative infectious complications as identified by ICD codes in the 6 months after surgery. METHODS Logistic regression models were constructed using age at surgery, preoperative hemoglobin A1c, and preoperative BMI as predictors for the odds of infectious complications following surgery. RESULTS Age, BMI, and preoperative hemoglobin A1C were all found to be significant predictors of the odds of infection following spinal surgery. Increasing age was associated with a small (0.9% per year of age) relative risk, whereas increasing BMI (per 1kg/m^2) was associated with a 2.7% increase in relative risk, and hemoglobin A1c was associated with a 4.2% increase in relative risk per 1 percent increase in the lab value. Twenty-eight percent of patients had their hemoglobin A1c checked prior to surgery, this group had a much higher infection rate (43.5% greater relative risk) than those patients who were not tested, regardless of the actual hemoglobin A1c level. CONCLUSIONS BMI and hemoglobin A1c were significant predictors of postoperative infection in our study sample. This is the largest study to date on the subject and the first to our knowledge to establish a dose-response relationship between these comorbid factors and the risk of postoperative complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Prospective controlled cohort study of Troponin I levels in patients undergoing elective spine surgery for degenerative conditions: Prone versus supine position

Prior studies have suggested that elevated serum Troponin-I (TnI) levels immediately after non-cardiac surgical procedures (8–40%) represent subclinical cardiac stress which independently predicts increased 30-day mortality. Routine post-operative TnI monitoring has therefore been suggested as a standard of care. However, no prior studies have focussed on elective degenerative spine surgery, whilst few have measured pre-op TnI. Further, prolonged prone positioning could represent an additional, independent, cardiac stress. We planned a prospective controlled cohort study of consecutive TnI levels in routine elective spine surgery for degenerative spine conditions, incorporating 3 groups: ‘prone<2h’, ‘prone>2h’ and ‘supine’ positioning. TnI levels (>0.04μg/L) were recorded immediately pre-/post-surgery, and by 24h of surgery. N=120 patients were recruited. Complete results were obtained in 92 (39 supine, 53 prone). No significant between-groups differences were observed in demographic or cardiovascular risk factors. Validated TnI-elevation by 24h was not observed in any group. Spurious elevations were recorded in one ‘prone<2h’ and one ‘prone>2h’. One non-ST segment myocardial infarction (STEMI) occurred on day 7 without TnI elevation by 24h (prone>2h). There was no 30-day mortality. Conclusions: Despite a lower cut-off, no validated TnI elevation was observed in any group by 24h after surgery. One non-STEMI had not been associated with TnI-elevation by 24h. Immediately peri-operative cardiac stress therefore appeared comparatively rare in patients undergoing routine elective spine surgery. Further, prone positioning did not represent an additional, independent, risk. Routine immediately post-operative TnI monitoring in elective spine surgery therefore appears unjustified. Our study highlighted several caveats regarding consecutive TnI testing.

Surgical outcome in patients with coexisting multiple sclerosis and spondylosis.

Multiple sclerosis (MS) is a neuro-degenerative disease of unknown etiology which results in destruction of myelin. A variety of neurologic signs and symptoms are associated with MS and include myelopathy, extremity weakness, low back pain, sciatica and paresthesias. Many of these signs and symptoms are identical to those experienced by patients with spondylosis (e.g. spinal stenosis, disc herniations). The coexistence of MS with spondylosis can be problematic both for diagnosis and treatment. During the period 1992 to 1996 we identified 7 patients with previously diagnosed MS who developed new syndromes which were thought to be related to a variety of degenerative spine conditions. The diagnosis of MS was based on standard clinical, immunological and neuroradiological criteria. Five of 7 patients demonstrated significant improvement after surgery. One patient experienced a transient MS exacerbation after surgery. From our series we concluded that surgery for degenerative spine conditions can be performed in a safe and effective manner in patients with coexisting multiple sclerosis.