Types Of Spine Surgery Research Articles

The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients with Scoliosis and Cerebral Palsy.

Cohort study. Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP). A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery. Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0-4, SAS 5-6, SAS 7-8, SAS 9-10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. Area under curve (AUC) is reported. A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0-4; 51.6%, SAS 5-6; 30.2%, SAS 7-8; 18.5%, SAS 9-10; 0/0. When the SAS 7-8 group was set as the reference, there was no significant difference compared to SAS 5-6 (P=0.34), while the incidence rate was significantly increased in SAS 0-4 (P=0.02). The AUC was 0.65 (95% Confidence Interval: 0.54-0.75). Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0-4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.

Application of Escherichia coli-Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures.

(1) Background: Recently, Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E. coli-derived rhBMP-2) has been increasingly applied to different types of spinal surgeries and reported to achieve successful fusion. This pilot study aimed to evaluate the clinical efficacy and safety of rhBMP-2 in patients undergoing posterior instrumented fusions for unstable spinal fractures. (2) Methods: This study included ten consecutive patients undergoing spinal surgery using E. coli-derived rhBMP-2 with more than one year of follow-up. Radiologic outcomes were compared, including the average fracture healing period, local kyphosis correction, and clinical outcomes between preoperative and the last follow-up. (3) Results: The average time of radiographic union was 99.9 ± 45.4 (62-192) days, with an average use of 5.2 ± 3.9 months of anabolic agents. Radiologic parameters such as anterior vertebral height and vertebral wedge angle were significantly corrected postoperatively and at the last follow-up. Clinical outcomes other than leg pain were significantly improved after the surgery. In addition, four patients with preoperative neurologic deficits showed improved neurologic status. (4) Conclusions: Combined with the anabolic agents, applying E. coli-derived rhBMP-2 to the fractured vertebral body could be an effective surgical treatment for unstable spinal fractures. Further trials are needed to validate this result.

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery.

Intracranial hemorrhage after spinal surgery is a rare and devastating complication. To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Professional and ethical approaches to characterize complications in elective spinal neurosurgery. Never events in lumbar discectomy

Any surgical intervention is associated with the possible development of complications. Surgical complications are traditionally an unpopular topic for discussion, but in recent decades they have received increased attention, due to both medical and economic factors. This review discusses the general concepts that characterize the negative consequences of surgical interventions in spinal neurosurgery: complications, adverse events, sentinel events, never events, collateral adverse outcomes. Classifications are given that allow systematizing these negative phenomena. Surgical treatment of the lumbar disk herniation is the most frequently performed spinal surgery. The true number of lumbar discectomies is difficult to estimate because this procedure is often not an isolated surgical intervention, but a step in a larger one. Being a routine surgical procedure, discectomy, performed in one or another way depending on the preferences of the surgeon and available equipment, is characterized by a rather low relative frequency of adverse events and complications compared to other types of spinal surgery. However, due to the significant number of interventions, the absolute figures may present a medical and economic problem. Most authors refer to the classic triad of “wrong level, wrong side, wrong patient” and foreign bodies in the area of surgical intervention as obvious medical errors. Damage to the intestine or peritoneum, trauma to the great vessels and trauma to the nerve roots are considered serious complications, but not always medical errors. The other most commonly reported adverse events of lumbar discectomy are durotomy, neurological complications, surgical wound complications, recurrent disc herniation, and reoperation. Until now, no clear classification of the negative consequences of lumbar discectomy, which would allow to verify the relationship between intraoperative adverse events (both surgical and anesthetic) and postoperative complications has been developed. In addition, it is extremely difficult, based on the criteria available in the literature, to identify a medical error in a number of iatrogenic complications, which requires further comprehensive study of the problem, since it has not only medical, but also legal consequences.

SILVER-COATED IMPLANTS IN SPINE SURGERY

Infections in spine surgery are relatively common and devastating complications, a significant burden to the patient and the healthcare system. Usually, the treatment of SSIs consists of aggressive and prolonged antibiotic therapy, multiple debridements, and in chronic cases, hardware removal. Infections are correlated with worse subjective outcomes and even higher mortality.Depending on the type of spine surgery, the infection rate has been reported to be as higher as 20%. Recently silver-coated implants have been introduced in spine surgery to reduce the incidence of post-operative infections and to improve implant survivorship.The aim of the present study is to evaluate complications and outcomes in patients treated with silver-coated implants because of spine infection.All consecutive patients who had spine stabilization with a silver-coated implant from 2018 to 2021 were screened for inclusion in the study. Inclusion criteria were: (1) six months of minimum follow-up; (2) previous surgical site infection; hematogenous spondylodiscitis requiring surgical stabilization. Demographic and surgical information were obtained via chart review, all the device-related complications and the reoperation rate were also reported.A total of 57 patients were included in the present study. The mean age was 63.4 years, and there were 36 (63%) males and 21 (37%) females. Among the included cases, 57% were SSIs, 33% were spondylodiscitis, and 9% were hardware mobilization.Comorbidities such as diabetes mellitus, obesity, smoke, and oncological history were significant risk factors. In addition, the organisms cultured were Staphylococcus species in most of the cases. At six months of follow-up, 40% of patients were considered free from infection, while 20% needed multiple surgeries.The present research showed satisfactory results of silver-coated implants for the treatment of spine infection.

Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time?

Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics. The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method. 12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24months following spine surgery. Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time. Level IV (retrospective cohort study).

The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery.

Frailty has been shown to be a risk factor of perioperative adverse events (AEs) in patients undergoing various types of spine surgery. However, the relationship between frailty and patient-reported outcomes (PROs) remains unclear. The primary objective of this study was to determine the impact of frailty on PROs of patients who underwent surgery for thoracolumbar degenerative conditions. The secondary objective was to determine the associations among frailty, baseline PROs, and perioperative AEs. This was a retrospective study of a prospective cohort of patients older than 55 years who underwent surgery between 2012 and 2018. Data and PROs (collected with EQ-5D, Physical Component Summary [PCS] and Mental Component Summary [MCS] of SF-12, Oswestry Disability Index [ODI], and numeric rating scales [NRS] for back pain and leg pain) of patients treated at a single academic center were extracted from the Canadian Spine Outcomes and Research Network registry. Frailty was calculated using the modified frailty index (mFI), and patients were classified as frail, prefrail, and nonfrail. A generalized estimating equation (GEE) regression model was used to assess the association between baseline frailty status and PRO measures at 3 and 12 months. In total, 293 patients with a mean ± SD age of 67 ± 7 years were included. Of these, 22% (n = 65) were frail, 59% (n = 172) were prefrail, and 19% (n = 56) were nonfrail. At baseline, the three frailty groups had similar PROs, except PCS (p = 0.003) and ODI (p = 0.02) were worse in the frail group. A greater proportion of frail patients experienced major AEs than nonfrail patients (p < 0.0001). However, despite the increased incidence of AEs, there was no association between frailty and postoperative PROs (scores on EQ-5D, PCS and MCS, ODI, and back-pain and leg-pain NRS) at 3 and 12 months (p ≥ 0.05). In general, PROs improved at 3 and 12 months (with most patients reaching the minimum clinically important difference for all PROs). Although frailty predicted postoperative AEs, mFI did not predict PROs of patients older than 55 years with degenerative thoracolumbar spine after spine surgery.

Predictors of Medical Malpractice Outcomes After Spine Surgery: A Comprehensive Analysis From 2010 to 2019.

Retrospective review of spine surgery malpractice cases. The aim was to compare medical malpractice outcomes among different types of spine surgery and identify predictors of litigation outcomes. Spine surgery is highly litigious in the United States with data suggesting favorable outcomes for defendant surgeons. However, factor specific data and explanations for plaintiff verdicts are lacking. Westlaw legal database was queried for spine surgery malpractice outcomes from 2010 to 2019. Clinical data, reasons for litigation, and legal outcomes were tabulated. Statistical analysis was performed to identify factors associated with litigation outcomes. A total of 257 cases were identified for inclusion. There were 98 noninstrumented and 148 instrumented cases; 110 single-level and 99 multilevel; 83 decompressions, 95 decompression and fusions, and 47 fusion only. In all, 182 (71%) resulted in a defendant verdict, 44 (17%) plaintiff verdict, and 31 (12%) settlement. Plaintiff verdicts resulted in payouts of $2.03 million, while settlements resulted in $1.11 million (P=0.34). Common reasons for litigation were intraoperative error, hardware complication, and improper postoperative management. Cases were more likely to result for the plaintiff if postoperative cauda equina syndrome (55% vs. 26%, P<0.01), a surgical site infection (46% vs. 27%, P=0.03), or other catastrophic injury (40% vs. 26%, P=0.03) occurred. Higher monetary awards were associated with multi versus single-level (median: $2.61 vs. $0.92 million, P=0.01), improper postoperative management cited (median: $2.29 vs. $1.12 million, P=0.04), and permanent neurological deficits ($2.29 vs. $0.78 million, P<0.01). Plaintiff payouts were more likely if defendant specialty was neurosurgery versus orthopedic surgery (33% vs. 18%, P=0.01). Spine surgery is a litigious field with multiple factors associated with outcomes. Efforts to reduce intraoperative errors and complications may improve patient care and decrease the risk of litigation.

Can spinal deformity patients maintain proper arm positions while undergoing full-body X-ray?

The compliance rate of arm positioning during full-body X-rays varies depending on operative status (preoperative vs postoperative), age, and diagnosis. Retrospective cohort. Despite the importance of patients maintaining arms in the same position in preoperative and postoperative standing films, patients are known to have their arms in varying positions, confounding radiographic interpretation and making global sagittal and coronal spinal balance assessment variable and potentially less reliable. This study seeks to examine arm position compliance among adult and pediatric surgical spinal deformity patients undergoing total body X-rays over the course of 4years (2015-2018). A retrospective radiographic review was performed on 382 spinal deformity patients from July 2015 to July 2018. The study's dependent variable of interest was standardized arm position (fingers on the clavicles with shoulders in 45° of forward elevation while the patient is in a free-standing posture) observed during full-body X-rays obtained for spinal deformity evaluation. Deviations and compliance to the standard protocol for full-body X-ray arm positioning was recorded and analyzed across various independent factors, including year of surgery, pre- and postoperative periods, type of spine surgery, and patient age. Chi-square and Cochran-Armitage analyses were performed to study categorical and trends, respectively. The overall compliance rate for maintaining standardized arm position was 90% for all 370 patients (277 adult and 93 pediatric), in preoperative and postoperative setting. Adults were more likely to follow protocol than pediatric patients (92.9% vs. 82.4%, P value = 0.003). The postoperative setting observed a significantly lower overall compliance rate when compared to the preoperative period (67.8% vs. 87.0%, P value < 0.0001). Patients undergoing neuromuscular scoliosis (73.3%), vertebral column resection (VCR) (70%), and growing rod lengthening (GRL) (57.1%) had the lowest overall compliance rate in the preoperative setting. In the postoperative setting, patients with GRL, VCR, revision congenital scoliosis, congenital scoliosis, neuromuscular scoliosis, and pedicle subtraction osteotomy (PSO) surgeries were compliant less than or equal to 50% of the time. From 2015 to 2018, there was an overall statistically significant increase in compliance rate (61.1% to 90.6%). Over the study period, adult patients became significantly more compliant to protocol. This was not observed in the pediatric population. This study documented the patient compliance rate of maintaining standardized arm position during full-body X-rays of spinal deformity patients. The overall compliance rate was 90.0% for all patients in the preoperative and postoperative setting. Risk factors for lower compliance rates included patients that were pediatric, postoperative, neuromuscular, and those who underwent a complex vertebral osteotomy or GRL. There was a trend showing improved compliance rate throughout the 4-year study period, which highlights the importance of having an ancillary staff who is comfortable with a consistent standard of care protocol. These results should help other centers optimize arm positioning in their patients undergoing full-body X-rays in the future.

Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study

Background contextPreoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of preoperative anemia is based on guidelines made by the American College of Cardiology (ACC), which recommends packed red blood cell transfusion when hematocrit is less than 21% in patients without cardiovascular disease and 24% in patients with cardiovascular disease. The literature has yet to quantify the risk profile associated with preoperative pRBC transfusion. PurposeTo determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery. Study designRetrospective review of a national surgical database. Patient sampleThe national surgical quality improvement program database Outcome neasuresPostoperative physiologic complications after a preoperative transfusion. Complications were defined as the occurrence of any DVT, PE, stroke, cardiac arrest, myocardial infarction, longer length of stay, need for mechanical ventilation greater than 48 h, surgical site infections, sepsis, urinary tract infections, pneumonia, or higher 30-day mortality. MethodsThe national surgical quality improvement program database was queried, and patients were included if they had any type of spine surgery and had a preoperative transfusion. ResultsPreoperative pRBC transfusion was found to be protective against complications when the hematocrit was less than 20% and associated with more complications when the hematocrit was higher than 20%. In patients with a hematocrit higher than 20%, pRBC transfusion was associated with longer lengths of stay, and higher rates of ventilator dependency greater than 48 h, pneumonia, and 30-day mortality. ConclusionThis is the first study to identify an inflection point in determining when a preoperative pRBC transfusion may be protective or may contribute to complications. Further studies are needed to be conducted to stratify by the prevalence of cardiovascular disease.

44. The impact of frailty on patient reported outcome measures following elective thoracolumbar spine surgery

BACKGROUND CONTEXT Frailty has been shown to be a risk predictor for perioperative adverse events (AEs) in patients undergoing various type of spine surgery. However, its relationship with Patient Related Outcome Measures (PROMS) remains unknown. PURPOSE The primary objective of this study was to determine the impact of frailty on PROMS in patients undergoing surgery for thoracolumbar degenerative conditions. The secondary objective was to determine the association between frailty and baseline PROMS. STUDY DESIGN/SETTING This is a retrospective study of a prospective cohort of patients who underwent surgery between 2012 and 2018. PATIENT SAMPLE Patients >55 years old who underwent surgery for thoracolumbar degenerative conditions. OUTCOME MEASURES Patient data and PROMS (EQ-5D, SF-12, ODI, back and leg pain NRS) were extracted from the Canadian Spine Outcomes and Research Network registry for a single academic center. Frailty was retrospectively calculated using the modified frailty index (mFI) and patients were classified as frail, prefrail and nonfrail. METHODS Patient characteristics and outcomes were analyzed using ANOVA or Kruskal-Wallis test for continuous variables and chi-square or Fisher's exact test for proportions. A generalized estimating equations (GEEs) regression model was used to assess the association between patients’ baseline frailty status and PROMs measures at three and 12 months. RESULTS A total of 293 patients were included with a mean age of 67±7 years. Twenty-two percent of the patients (n= 65) were frail, 59 % (n=172) were prefrail and 19% (n=56) were nonfrail. At baseline, the three groups had similar PROMS, except for the PCS which was worse in the frail group (mean difference [95% CI], -4.9 [-8.6;-1.1], p= 0.0083). The improvement in the EQ-5D, PCS, MCS, ODI, back and leg pain NRS scores was not significantly different between the three groups (p> 0.05). The was no difference in the evolution of the PROMS at three and 12 months between the three groups (p> 0.05). CONCLUSIONS Although frailty is a known predictor of AEs, it does not predict worse PROMS after spine surgery in that population. At baseline, nonfrail, prefrail and frail patients have similar PROMS. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Postoperative Sexual Activity Recommendations: Survey of Neurosurgeons/Spine Surgeons

The impact of various types of spinal surgeries on sexual health and postoperative sexual activity is a common question among both patients and health care professionals. Unfortunately, there is no clear answer to this question in the scientific literature. Our goal was to survey the current practices and recommendations of neurosurgeons to see if there was a clinical consensus. Participants in the survey included 50 spine surgeons: 47 males and 3 females. The average age of the participants was 45.7 years old, and the number of years of practice after residency was on average 11.7 years. Additional survey questions included the number of weeks recommended for patients to abstain before returning to sexual activity after specified small, medium, and large spinal surgeries. We found that there were no statically significant correlations between the participants' ages or years post residency and the time response for postoperative return to sexual activity. Some answers were significantly different among the participants. The results also showed a trend for spine surgeons to recommend longer intervals for return to sexual activities after more involved surgical procedures. The survey results and comments demonstrate the complete lack of physician consensus regarding recommendations for postoperative return to sexual activity and the need for further study.

Spine Surgery Supported by Augmented Reality.

Study Design:A prospective, case-based, observational study.Objectives:To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery.Methods:In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation.Results:AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably.Conclusions:Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.

Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries.

Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment. To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery. A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016. The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P < .01). This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

Lack of Current Recommendations for Resuming Sexual Activity Following Spinal Surgery.

Patients are faced with many questions surrounding the after effects of the various surgical procedures and their ability to return to preoperative activities. While patients often question whether surgery would provide alleviation of pain, weakness, and instability, they often have additional questions about sexual activity during their convalescence that are not always addressed. Although the literature shows postsurgical improvement in sexual activity in association with improved low back pain, reports vaguely address the variability in sexual activity recommendations based on anatomic location and type of spinal surgery. We conducted a PubMed search of the English language from 1990 to 2018 with the following keywords: sexual activity, postoperative, spinal fusion, spinal decompression, functional outcomes, laminectomy, rehabilitation, biomechanics, lumbar disc surgery, metabolic energy expenditure, coital position, and Oswestry Disability Index. Additional studies are needed that survey both patients and spine surgeons to examine current recommendations and to help formulate future guidelines.

Incidence and risk factors for hip fracture in elderly patients undergoing lumbar spine surgery: a nationwide database study with 11-year follow-up.

Spinal surgeries are performed to treat spondylolisthesis, fractures, scoliosis, or other deformities. Impaired balance mechanisms and functional movement may occur after spinal surgery. Fall episodes may cause hip fractures, which have negative impacts on quality of life and increase mortality. The incidence of hip fracture after spinal surgery is still unknown. The aim of this study was to examine the association between various types of spinal surgeries and hip fractures in the elderly by using a nationwide database. We hypothesized that the spinal surgeries may increase hip fracture risk in the elderly. We used the National Health Insurance Research Database (NHIRD) to identify 3345 patients undergoing spinal surgery and a random dataset to identify 6690 age-, sex- and Charlson comorbidity index (CCI)-matched controls to compare the incidence of hip fractures in an 11-year follow-up period. We also enrolled 82,730 patients with spinal surgeries from the inpatient dataset to investigate the impact of different types of spinal surgeries. Patients who received spinal surgeries had higher risks of hip fractures, especially patients aged 60 to 79years and female patients. The patients with long-segment thoracolumbar spinal fusions had a significantly higher risk of hip fracture than those with only discectomies. Short segmental lumbar spine fusions also slightly increased the risk of hip fracture compared with discectomies. Fall prevention for the elderly undergoing lumbar spinal surgery is necessary due to the highly increased hip fracture risk.

Impact of Depression on Patient-Reported Outcome Measures After Lumbar Spine Decompression.

A retrospective cohort study. The aim of this study was to investigate the effect depression has on the improvement of patient-reported outcome measures (PROMs) following lumbar decompression. Decompression without fusion is a viable treatment option for lumbar spine stenosis. Depression reportedly has a negative impact on PROMs after certain types of spine surgery, though verification of this with new, more precise outcome measures is needed. We included consecutive adult patients who underwent lumbar decompression for lumbar spine stenosis between 2016 and 2017 who had PROM information system (PROMIS) physical function, pain, depression, and Oswestry Disability Index (ODI) questionnaires completed preoperatively and at 6-month follow-up. Patients with a PROMIS depression score >50 or <50 were allocated to the depressed and not depressed groups, respectively. The cohorts were compared using unpaired t tests and repeated-measures two-way analysis of variance (ANOVA) with statistical significance taken at P < 0.05. The analysis included 55 patients without depression and 56 patients with depression. Depressed patients had worse preoperative PROMIS physical function (30.08 vs. 36.66, P = 0.005), PROMIS pain (69.36 vs. 64.69, P < 0.0001), and ODI scores (51.92 vs. 36.35, P < 0.0001). Similarly, the depressed group had worse postoperative PROMIS physical function (36.29 vs. 40.34, P = 0.005), PROMIS pain (60.16 vs. 54.87, P < 0.0001), and ODI scores (37.01 vs. 23.44, P = 0.0003). We observed a statistically significant interaction between depression status and pre to postoperative improvement in outcome for PROMIS physical function (F[1,109] = 102.5, P < 0.0001) and depression scores (F[1,109] = 15.38, P = 0.0002). No interaction was found for pain and ODI scores. Our results suggest that depressed patients experience a greater magnitude of improvement in PROMIS physical function and depression scores than nondepressed patients. Despite this, depressed patients have worse postoperative outcomes for PROMIS physical function, depression, pain, and ODI. These findings are important for risk stratifying and treating depressed patients before lumbar spine decompression. 3.

The current state of the evidence for the use of drains in spinal surgery: systematic review.

Search for evidence pertaining to the effectiveness of drains used in spinal surgeries. PubMed and EMBASE databases were searched for articles pertaining to the use of drains in all types of spinal surgery. The bibliographies of relevant studies were searched for additional papers that met the initial inclusion criteria. Level I and II studies were scored according to guidelines in the Cochrane Collaboration Back Review Group. We utilised the Population, Intervention, Comparison, Outcomes and Study design (PICOS) method to define our study eligibility criteria. Nineteen papers were identified: four level I studies, eight level III studies and seven level IV studies. The four level I, involving the randomization of patients into 'drain' and 'non-drain' groups, identified a total of 363 patients. Seven of the eight level III retrospective studies concluded that the use of drains did not reduce complications. Two of the seven level IV studies agreed with this conclusion. The remaining five level IV studies reported the benefits of lumbar drainage following dural tears. There is a paucity of published literature on the use of drains following spinal surgery. This is the first study to assess the evidence for the benefits of drains post-operatively in spinal surgery. The identified studies have shown that drains do not reduce the incidence of complications in anterior cervical discectomy and fusion, one and two level posterior cervical fusions, lumbar laminectomies, lumbar decompressions or discectomies and posterior spinal fusion for adolescent scoliosis. Further level I and II studies are needed.

The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery

(Abstracted from Anesth Analg, 122:1646–1653, 2016) Patients undergoing multilevel deformity-correction spine surgery may experience substantial inflammatory, muscular, neuropathic, and postsurgical pain, which increases chronic opioid use and incidence of opioid-related complications. Previous studies have shown α2 agonists to have an opioid-sparing effect in certain types of spine surgery.

Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 564 Patients.

Prognostic study-case controlled. Describe the rate of neurologic complications in adult spinal deformity surgery and describe the effect of these complications on clinical outcomes. The incidence of neurologic complications and the risk factors for neurologic complications have not been reported in a large series of patients with adult spinal deformity (ASD). Existing series include a mixed patient cohort undergoing different types of spine surgery. Patients with ASD undergoing surgery between 2008 and 2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, and radiographic and clinical outcomes were compared. A subanalysis of those with surgical and nonsurgical (e.g., stroke) neurologic complications was performed. Statistical analysis included t tests or χ tests as appropriate and a multivariate analysis. A P value of less than 0.025 was considered significant. A total of 564 patients met the inclusion criteria. The average age was 57 years. There were a total of 116 neurologic complications in 99 patients (17.6%). There were 88 surgical procedure-related neurologic complications in 77 patients (13.7%) and 28 nonsurgical neurologic complications in 28 patients (5.0%). The most common complications were radiculopathy (30%), motor deficits (22%), mental status changes (12%), and sensory deficits (12%). Revisions (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4) and interbody fusions (OR 2.1, 95% CI 1.4-3.2) were associated with an increased risk of neurologic complications. Decompression and osteotomies (including three-column osteotomies) did not increase the risk of neurologic complications. Patients with neurologic complications were not more likely to sustain other complications; however, they were more likely to undergo another operation during the follow-up period (OR 1.9, 95% CI 1.3-2.8). The overall incidence of neurologic complications in ASD surgery was 17.6%. The incidence of surgical neurologic complications was 13.7%. There was a higher risk of neurologic complications in revision cases and in cases in which interbody fusion was required. 3.