Undergoing Lumbar Arthrodesis Research Articles

Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set.

Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology. The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery. The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach. Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.

The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series.

The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and surgical risk factors involved in the development of adjacent-level syndrome. A single-center retrospective analysis of adult patients undergoing lumbar fusion procedures between January 2014 and December 2018 was performed. Clinical, demographic, radiological, and surgical data were collected. Patients who underwent surgery for adjacent-segment disease (ASD) were classified as the ASD group. All patients were evaluated 1 month after the surgical procedure clinically and radiologically (with lumbar radiographs) and 3 months afterward with CT scans. The last follow-up was performed by telephone interview. The median follow-up for patients included in the analysis was 67.2 months (range 39-98 months). A total of 902 patients were included in this study. Forty-nine (5.4%) patients required reoperation for ASD. A significantly higher BMI value was observed in the ASD group (p < 0.001). Microdiscectomy and microdecompression procedures performed at the upper or lower level of an arthrodesis without fusion extension have a statistically significant impact on the development of ASD (p = 0.001). Postoperative pelvic tilt in the ASD group was higher than in the non-ASD group. Numeric rating scale, Core Outcome Measures Index, and Oswestry Disability Index scores at the last follow-up were significantly higher in patients in the ASD group and in patients younger than 65 years. Identifying risk factors for the development of adjacent-level syndrome allows the implementation of a prevention strategy in patients undergoing lumbar arthrodesis surgery. Age older than 65 years, high BMI, preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt are the most relevant factors. In addition, patients older than 65 years achieve higher levels of clinical improvement and postsurgical satisfaction than do younger patients.

Use of biphasic calcium phosphate versus demineralized bone matrix: retrospective clinical and CT analysis of posterolateral fusion results.

Bone graft extenders have been developed to prevent donor site morbidity associated with iliac crest bone graft, but few studies compared the efficacy of various substitutes. Our purpose was to determine fusion rate and clinical outcome in patients undergoing lumbar arthrodesis using demineralized bone matrix (DBM) and biphasic calcium phosphate (BCP). Patients with degenerative spondylolisthesis undergoing one-level or two-level arthrodesis of lumbar spine were retrospectively reviewed. Two treatment groups placed either BCP or DBM, in addition to local autograft in lumbar posterolateral space. Three-dimensional CT exam and dynamic flexion-extension radiographs at postoperative 2-year were assessed for posterolateral fusion status and pain scale and Oswestry Disability Index (ODI) for clinical outcome. Of the 148 patients reviewed (including 23 in one- and 58 patients in two-level in BCP group, and 47 in one- and 20 patients in two-level in DBM group), no significant differences were found in terms of age, sex, BMI, smoking, diabetes, steroids, number of level fused, non-union rate or revision surgery between BCP and DBM groups. Significantly improved pain scale of back and leg and ODI were found in both groups postoperatively without group difference. We found a comparable fusion rate in one-level surgery (100% versus 93.6%) and a superior fusion rate of BCP group in two-level surgery (98.3% versus 80.0%, p = 0.01). Being a bone graft extender without osteoinductive property, with local autograft, BCP is comparable to DBM for one- and superior for two-level fusion. No significant difference was found in clinical outcomes.

68. PROMIS physical function and pain interference are independent predictors of unplanned readmission after instrumented lumbar spinal arthrodesis

<h3>BACKGROUND CONTEXT</h3> Risk stratification is essential for informed decision-making and patient counseling. The PROMIS physical function computer adaptive test (PFCAT) and pain interference (PI) scales directly evaluate physical function and limitation due to pain with low question burden and may be clinically relevant predictors of adverse outcomes in spine patients. <h3>PURPOSE</h3> To evaluate whether preoperative PROMIS PFCAT or PI scores are important predictors of unplanned readmission in adults undergoing lumbar arthrodesis. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of a spine patient registry at a Level I academic center. <h3>PATIENT SAMPLE</h3> A total of 1,782 patients who underwent lumbar arthrodesis between 2015 and 2020 were included. <h3>OUTCOME MEASURES</h3> Primary outcome measures was unplanned hospital readmission. <h3>METHODS</h3> All cases with unplanned hospital readmission were adjudicated by manual chart review. We performed random forest prediction modeling to identify variables with the greatest predictive importance to unplanned hospital readmission risk using the mean decrease in Gini index. <h3>RESULTS</h3> Mean patient age was 62.8 (12.8) years. Mean BMI was 30.2 (6.4) kg/m2. Mean preoperative PFCAT was 33.8 (6.6) and mean PI was 66.5 (6.5). Preop CCI mean was 2.0 (2.5). Of 1,782 patients included, 146 patients (8.19%) had unplanned readmissions after surgery. In both model PFCAT and model pain interference, BMI had the greatest importance (68.9, 63.3, respectively). In model PFCAT, PFCAT had the second highest predictive importance (61.3), while in model pain interference PROMIS PI had the second greatest predictive importance (50.1). In both models, age (49.5, 46.7, respectively) and CCI (32.0, 28.7) were the third and fourth most important predictive variables for unplanned readmission, respectively. <h3>CONCLUSIONS</h3> Random forest modeling is a more flexible modeling technique than linear regression techniques, and therefore, can identify under-explored risk factors. Our analysis using random forest modeling identified BMI as the most important predictive variable for unplanned readmission, with PROMIS PFCAT and PROMIS PI demonstrating the next greatest predictive importance in respective models. Both models also included age and CCI as predictive variables of lesser importance. While traditionally used to assess post-treatment outcomes, PROMIS PFCAT and PI are stronger independent predictors of postoperative readmission than age or CCI. Further research to develop risk-stratification tools incorporating PROMIS measures and random forest models is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and non-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

BackgroundEnhanced recovery after surgery (ERAS) program is an evidence-based improvement over non-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with non-ERAS traditional care.MethodsDuring January 2018 to December 2018, patients enrolled received non-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected.ResultA total of 127 patients were enrolled, including 67 patients in the non-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6 ± 4.0 days) was significantly less than that of patients treated with non-ERAS traditional care (15.6 ± 3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the non-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%.ConclusionsBased on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than non-ERAS traditional care.

The effect of lumbar corticosteroid injections on postoperative infection in lumbar arthrodesis surgery

We sought to characterize the association between lumbar corticosteroid injections and postoperative infection rate for patients in the Military Health System undergoing lumbar arthrodesis. The Military Health System Data Repository was searched for all patients undergoing lumbar arthrodesis from 2009 to 2014. Current Procedural Terminology (CPT) codes were used to identify the subset of patients who also received preoperative lumbar corticosteroid injections. These patients were stratified by timing, type, and number of injections. Infection rates were compared to the control group of patients who did not receive preoperative lumbar corticosteroid injections. The search identified 3403 patients who had undergone lumbar arthrodesis from 2009 to 2014 within the Military Health System. 612 patients had received lumbar corticosteroid injections prior to surgery (348 epidural, 264 facet). The control group consisted of the remaining 2791 patients. Overall post-operative infection rate was 1.47% with an infection rate in the injection group of 1.14% versus 1.54% in the control group. When stratified by time, infection rates ranged from 0% to 1.85% in the injection groups. No differences between injection and control groups reached statistical significance in any subgroup analysis. Post-operative infection rate is not significantly increased in patients receiving lumbar corticosteroid injections (LCSIs) prior to lumbar arthrodesis. No differences were observed in infection rates based on timing, type, or number of injections prior to surgery.

Complications in Elderly Patients Undergoing Lumbar Arthrodesis for Spinal Stenosis

To report the perioperative complication rates in elderly patients undergoing lumbar arthrodesis and to analyze the risk factors. Between September 2015 and June 2018, 215 patients aged ≥70 underwent posterior lumbar arthrodesis with pedicle screw fixation. Demographic data including age, gender, smoking status, body mass index (BMI) and preoperative comorbidities were collected. Operative records as the number of levels fused, estimated blood loss, time of surgery, and the occurrence of perioperative complications were reviewed. Risk factors of perioperative complications were determined by logistic regression analysis. The total perioperative complication rate in all patients was 30.2%, of which major complications occurred in 24 patients (11.2%) and minor complications occurred in 41 patients (19.1%). Two risk factors of perioperative complications (major or minor) were chosen: BMI (cutoff value 24.32) and surgical level (≥3). Lower surgical level (≥3) and smaller BMI were risk factors for perioperative minor complications, and major complication was affected only by surgical level(≥3). The risk factor of perioperative complication in elderly patients after lumbar arthrodesis was fusion segment (≥3), and BMI was a protective factor. Elderly patients with BMI <24.32 are more likely to have perioperative complications after lumbar arthrodesis.

IMPACT OF THE MIS-TLIF TECHNIQUE ON THE SPINOPELVIC PARAMETERS OF PATIENTS WITH LUMBAR ARTHRODESIS

ABSTRACT Objective: To evaluate the influence of the MIS-TLIF technique on the spinopelvic parameters of patients submitted to lumbar arthrodesis up to three levels for the treatment of vertebral degenerative conditions without deformity. Methods: Retrospective radiographic evaluation of 52 patients submitted to the surgical treatment of lumbar arthrodesis using the MIS-TLIF technique in up to three levels. The spinopelvic parameters – pelvic incidence (PI), pelvic tilt(PT), lumbar lordosis (LL), segmental lordosis (Lseg), and the difference between lumbar lordosis and pelvic incidence (LL-PI mismatch) were analyzed in orthostatic lateral radiographs in the pre- and postoperative periods, with a minimum follow-up of 1 year. The patients were divided into three groups: PI &lt;45°, PI between 45° and 55° and PI &gt;55°. Results: Sixty-nine operated levels were evaluated in 15 patients with PI &lt;45°, 19 with PI between 45° and 55° and 18 with PI &gt;55°. The mean value of the pelvic incidence was 52.3° (± 11.5), lumbar lordosis 46.1° (pre)/45.6° (post); segmental lordosis 20.3° (pre)/20.6° (post); pelvic tilt 18.5° (pre)/18.2° (post); “mismatch” (PI-LL) 7° (pre)/ 6.6° (post), with no statistical difference among all parameters (p&gt;0.05). Conclusions: The MIS-TLIF technique had no influence on postoperative spinopelvic parameters of patients undergoing lumbar arthrodesis surgery. Level of evidence: III. Retrospective comparative study.

Retraction: Limited post-operative dexamethasone use does not affect lumbar fusion: a single institutional experience.

[This retracts the article DOI: 10.21037/jss.2018.05.20.].

Avaliação do tempo de dreno de sucção em pacientes submetidos à artrodese lombar: estudo prospectivo randomizado

Evaluation of the suction drain time in patients undergoing lumbar arthrodesis: prospective randomized study

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 75. Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use

BACKGROUND CONTEXT Opioid therapy is one of the most effective and commonly practiced methods to control acute postoperative pain. Concerns relating to the overwhelming use of prescription narcotics including an inherent risk of abuse and tolerance has been a contentious issue. In patients undergoing lumbar spine surgery, limited or no data exist on potential risk factors for prolonged postoperative opioid use. In the context of national concern, it is pertinent to define epidemiological trends and risk factors of opioids use in spine patients for practice surveillance, preventive strategies, and patient counseling and welfare. PURPOSE To investigate trends in postoperative narcotic use amongst preoperative opioid users (OU) versus opioid-naive (ON) patients, and identify factors associated with postoperative narcotic use at one year following lumbar arthrodesis. STUDY DESIGN/SETTING Retrospective, observational cohort study. PATIENT SAMPLE A total of 26,553 patients (OU: 58.3%) registered in the Humana Inc. claims dataset (2007 through 2016Q3) that underwent either anterior (ALIF), posterior or transforaminal lumbar interbody fusions (P/TLIFs), postero-lateral fusion (PLF) or a combination of ALIF and PLF. OUTCOME MEASURES Postoperative monthly opioid prescription filling rates up to one year in OUs and ON patients, and risk factors associated with prolonged opioid usage. Prolonged opioid use was defined as narcotic prescription filling at one year following lumbar arthrodesis. METHODS Using the Humana Inc. claims dataset (2007 through 2016Q3), we identified patients undergoing lumbar arthrodesis. Based on preoperative opioid use, patients were identified as an OU (history of the narcotic prescription filled within three months before surgery) or ON (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU and longitudinally tracked up to one year postoperatively for both OU and ON patients. Using log-binomial multivariable regression techniques, factors associated with opioid use at one year following lumbar arthrodesis. In an observational cohort study, we identified patients registered in the Humana Inc. claims dataset (2007 through 2016Q3) who underwent anterior (ALIF) or posterior/transforaminal lumbar interbody fusions (P/TLIFs), or postero-lateral fusion (PLF) or a combination of ALIF and PLF. Based on preoperative opioid use, patients were identified as an OU (history of the narcotic prescription filled within three months before surgery) or an ON (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU and trended for one year postoperatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at one year following lumbar surgery. RESULTS Overall, 26,553 patients (OU: 58.3%) underwent lumbar surgery (ALIF:8.5%; P/TLIF:43.8%; PLF:41.5%; ALIF+PLF:6.2%). At one month following surgery, 60.2% NOU and 82.9% OUs had a filled opioid prescription. At three months, rates of prescription opioids declined significantly to 13.9% in NOUs versus 53.8% in OUs, while plateauing at 6-12-month postoperative period (NOU:8.4-9.6%; OU:42.1-45.3%). At one year, significantly higher narcotic prescription filling rates was observed in OUs compared to NOUs (42.4% vs. 8.6%; p CONCLUSIONS Approximately one-third of patients used opioids prior to lumbar spine surgery. Postoperative opioid use fell dramatically during the first three months in ON patients, but nearly half of the preop opioid users will remain on narcotics at one year after primary lumbar arthrodesis. Our findings serve as a baseline in identifying patients at risk for chronic use and encourage discontinuation of opioids prior to lumbar spinal surgery owing to the risks associated with it. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Limited post-operative dexamethasone use does not affect lumbar fusion: a single institutional experience

The use of exogenous dexamethasone during and after lumbar spine surgery remains controversial. The preponderance of studies on this topic is primarily from animal models and little is known about the effects of exogenous dexamethasone use on fusion outcomes in human subjects undergoing lumbar arthrodesis. The aim of this study is to investigate the effect of limited exogenous dexamethasone use on bone fusion after instrumented lumbar arthrodesis. Consecutive adult patients (18 years and older) undergoing one and two level lumbar decompression and fusion between January 2013 and December 2014 were reviewed. Patients were dichotomized into one of two groups (A & B) based on whether they received dexamethasone-Group (A) dexamethasone; and Group (B) no dexamethasone. Baseline characteristics, operative details, length of hospital stay, rates of wound infection, and fusion rates at 1 year were gathered by direct medical record review. All patients enrolled in this study were followed for a minimum of 12 months after surgery. One hundred sixty-five consecutive patients undergoing 1- and 2-level fusions were included in the study. Fifty eight patients received dexamethasone and 107 patients did not. The mean ± SD age was similar between both cohorts ("dexamethasone": 58.12±16.25 years vs. "no dexamethasone": 61.00±12.95, P=0.24). The was no difference in the prevalence of smoking (P=0.72) between both cohorts. Length of in-hospital stay was similar between cohorts ("dexamethasone": 4.08±3.44 days vs. "no dexamethasone": 4.50±2.85 days, P=0.43). The incidence of post-operative infections was similar between cohorts. At 12 months after surgery, 70% of patients in the dexamethasone cohort had radiographic evidence of bony fusion compared to 73% of patients in the no-dexamethasone cohort (P=0.68). Our study suggests that a limited exposure to exogenous dexamethasone after lumbar spine fusion may not be associated with a lower fusion rate. Prospective randomized control trials are needed to corroborate our findings.

EFFECT OF PULSED ELECTROMAGNETIC FIELD ON THE CONSOLIDATION OF POSTEROLATERAL ARTHRODESES IN THE LUMBOSACRAL SPINE: A PROSPECTIVE, DOUBLE-BLIND, RANDOMIZED STUDY

ABSTRACT Objective: To assess the effect of pulsed electromagnetic field (PEMF) on the consolidation of instrumented lumbar posterolateral arthrodeses in patients who have been surgically treated for degenerative spine disease. Methods: Forty cases were recruited from 163 consecutive patients undergoing lumbar arthrodesis at the same center. The patients were randomized into two groups of 20 patients: Active Group, who were exposed to PEMF for 4 hours a day for 90 days after surgery, and Inactive Group, who received an identical device, with the same instructions for use but without the ability to generate PEMF. The patients underwent computed tomography scans at 45, 90, 180 and 360 days after surgery to check for the occurrence of arthrodesis at each operated spinal level. Results: In the course of the study, two patients were excluded from each group. There were no significant differences between the groups with respect to age, gender, smoking habit, or the number of vertebral levels included in the arthrodesis. The percentage of consolidation of the vertebral levels increased at 90, 180 and 360 days compared to 45 days (p&lt;0.001) in both groups. The Active Group had a 276% greater chance of consolidation in the vertebral levels (OR = 3.76; 95% CI: 1.39-10.20), regardless of the time of evaluation. Patients in the Active Group presented 16% more consolidation than patients in the inactive group (p=0.018). Conclusions: Post-operative exposure to PEMF following instrumented arthrodesis of the lumbar spine for degenerative spine disease increased consolidation in the first year after surgery.

Bone Morphogenetic Protein Use and Cancer Risk Among Patients Undergoing Lumbar Arthrodesis: A Case-Cohort Study Using the SEER-Medicare Database.

Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cancer on the basis of exposure to BMP. In the SEER-Medicare subcohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or with mortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]). In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Bone Morphogenetic Proteins in Lumbar Arthrodesis: What Is All the Debate About? Commentary on an article by Daniel C. Beachler, PhD, MHS, et al.: "Bone Morphogenetic Protein Use and Cancer Risk Among Patients Undergoing Lumbar Arthrodesis: A Case-Cohort Study Using the SEER-Medicare Database".

Controversy continues surrounding the use of recombinant human bone morphogenetic proteins (rhBMPs) in spine surgical procedures. At the present time, >20 BMPs have been discovered. Of these, the U.S. Food and Drug Administration (FDA) has only approved the use of one for lumbar arthrodesis: rhBMP-2. Since its approval in 2002, the use of rhBMP-2 in lumbar spine surgical procedures has varied, oscillating in response to FDA Public Health Notifications and professional society recommendations1. Prior to the 2008 FDA Public Health Notification concerning the safety of BMPs in cervical surgical procedures2, >50% of anterior lumbar interbody fusion procedures, 43% of posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures, and 30% of posterior lumbar fusion procedures utilized BMPs. In 2010, their use peaked, with 45.2% of lumbar arthrodeses using rhBMP-21. Following the 2008 FDA notification, the mean rate of BMP use in lumbar arthrodesis decreased steadily at 0.978% per month until the end of 20121. In their article, Beachler et …

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience.

Introduction: The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis.Methods: A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 – 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level.Results: Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis.Conclusion: The DTO system represents a novel hybrid dynamic stabilization and fusion construct. This 10-year experience found the device to be highly effective as well as safe. The technique may serve as an alternative to multilevel arthrodesis. Implantation of a motion-preserving dynamic stabilization device immediately adjacent to a fused level instead of extending a rigid construct may reduce the subsequent development of adjacent-segment disease in this patient population.

Postoperative comparison of the results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis

ObjectiveTo compare the postoperative results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis at up to three levels. MethodsForty-three patients who all underwent lumbar arthrodesis due to degenerative disc disease at one, two or three levels were evaluated. They were divided randomly into two groups: one received antibiotic prophylaxis with cefalotin (1g) and the other received the same antibiotic for five days. After the surgical intervention, the patients were evaluated at the time of hospital discharge, at the first return to the clinic (two weeks later) and 90 days after the date of the surgery with the surgical wound, with clinical examination of the surgical wound and laboratory tests on both groups. ResultsIt was observed that among the patients in the group with one day of antibiotic prophylaxis, 28.6% presented complications in the surgical wound, while in the group with five days, 27.9% presented complications. ConclusionThis study demonstrates that a single dose of antibiotic prophylaxis is as effective as a regimen of multiple doses in lumbar arthrodesis surgery at up to three levels. Thus, the costs and risks of subjecting patients to hospitalization under a prolonged drug regimen are unjustifiable.

Post Operative Comparison of the Results of the Use of Antibiotic Prophilaxis One and Five Days in Patients Undergoing Lumbar Arthrodesis

Post Operative Comparison of the Results of the Use of Antibiotic Prophilaxis One and Five Days in Patients Undergoing Lumbar Arthrodesis

Comparação pós‐operatória dos resultados do uso de antibioticoprofilaxia por um e cinco dias em pacientes submetidos à artrodese lombar

ObjectiveTo compare the postoperative results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis at up to three levels. MethodsForty‐three patients who all underwent lumbar arthrodesis due to degenerative disc disease at one, two or three levels were evaluated. They were divided randomly into two groups: one received antibiotic prophylaxis with cefalotin (1g) and the other received the same antibiotic for five days. After the surgical intervention, the patients were evaluated at the time of hospital discharge, at the first return to the clinic (two weeks later) and 90 days after the date of the surgery with the surgical wound, with clinical examination of the surgical wound and laboratory tests on both groups. ResultsIt was observed that among the patients in the group with one day of antibiotic prophylaxis, 28.6% presented complications in the surgical wound, while in the group with five days, 27.9% presented complications. ConclusionThis study demonstrates that a single dose of antibiotic prophylaxis is as effective as a regimen of multiple doses in lumbar arthrodesis surgery at up to three levels. Thus, the costs and risks of subjecting patients to hospitalization under a prolonged drug regimen are unjustifiable.

A novel minimally invasive technique for lumbar decompression, realignment, and navigated interbody fusion

We present a novel, minimally invasive, navigation-guided approach for surgical treatment of degenerative spondylolisthesis (DS) that is a hybrid of the two most common techniques, posterior interbody fusion (PLIF) and transforaminal interbody fusion (TLIF). DS is an acquired condition with intersegmental instability of one or more lumbar motion segments. Seven patients with single level lumbar DS underwent lumbar arthrodesis utilizing the hybrid technique (HLIF) in our center. Using a standard unilateral midline approach a decompression and partial facetectomy on one side was performed, allowing for implantation of a specially designed interbody cage. Pedicle screws were placed using neuronavigation in a vertical vector on the side of the partial facetectomy and dorsolaterally (percutaneous) on the contralateral side. Patient and operative data, numeric rating scale (NRS) pain scores, core outcome measures index (COMI) and Oswestry disability index (ODI) were recorded preoperatively as well as 6 weeks, 3months, 6months and 1year after surgery. All patients completed the 1year follow-up. There was significant postoperative improvement of NRS, COMI and ODI scores at all postoperative follow-up time points (p<0.05). The radiological assessments of realignment showed a reduction of listhesis from an average of 21.04% (standard deviation [SD] 5.1) preoperatively to 9.14% (SD 4.0) postoperatively (p<0.001). The average blood loss was 492ml. Post-procedure CT scans demonstrated correct implant placement in all but one patient who required a revision of a single pedicle screw. HLIF allows thorough decompression as well as realignment and interbody fusion for patients with DS and may help reduce tissue trauma in comparison to other minimally invasive lumbar fusion techniques.