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Clinical Spine Surgery

Daniel D Bohl, Ankur S Narain, Fady Y Hijji, Junyoung Ahn, Benjamin C Mayo, Dustin H Massel, William W Long, Krishna D Modi, Kern Singh
STUDY DESIGN/SETTING: This is a retrospective analysis of a prospectively maintained surgical registry. OBJECTIVE: To characterize postoperative narcotic consumption in patients undergoing either an anterior lumbar interbody fusion (ALIF) or a lateral lumbar interbody fusion (LLIF). BACKGROUND CONTEXT: There is substantial interest in evaluating the safety, efficacy, and outcomes following minimally invasive techniques for lumbar fusion procedures...
February 23, 2017: Clinical Spine Surgery
Chao Liu, Wen Yu, Guoquan Zheng, Yue Guo, Kai Song, Xiangyu Tang, Zheng Wang, Yan Wang, Yonggang Zhang
STUDY DESIGN: This is a retrospective clinical study. OBJECTIVE: To investigate the correction angle and safety of the spinal osteotomy at the T12 or L1 vertebra. SUMMARY OF BACKGROUND DATE: Monosegment subtraction osteotomy cannot effectively correct severe kyphosis in ankylosing spondylitis (AS), generally 2-level spinal osteotomy was taken for achieving expected correction. According to literature, the T12 or L1 were usually taken as the upper spinal osteotomy vertebra...
February 23, 2017: Clinical Spine Surgery
Young-Seop Park, Seung-Jae Hyun, Jong-Hwa Park, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
STUDY DESIGN: This was a retrospective clinical case series. OBJECTIVE: The purpose of this study was to evaluate mid-term outcomes of S2 ala-iliac (S2AI) screw fixation in patients who underwent multilevel posterior spinal fusion surgery. SUMMARY OF BACKGROUND DATA: There have been few reports on radiographic and clinical outcomes in patients who underwent spinopelvic reconstruction surgery using S2AI screw installation. MATERIALS AND METHODS: Twenty-three patients were treated by a single spinal surgeon between September 2013 and June 2014 utilizing segmental instrumentation with pedicle and S2AI screw...
February 23, 2017: Clinical Spine Surgery
Christopher K Kepler
An understanding of randomization is important both for study design and to assist medical professionals in evaluating the medical literature. Simple randomization can be done through a variety of techniques, but carries a risk of unequal distribution of subjects into treatment groups. Block randomization can be used to overcome this limitation by ensuring that small subgroups are distributed evenly between treatment groups. Finally, techniques can be used to evenly distribute subjects between treatment groups while accounting for confounding variables, so as to not skew results when there is a high index of suspicion that a particular variable will influence outcome...
February 23, 2017: Clinical Spine Surgery
John I Shin, Jun S Kim, Jeremy Steinberger, John DiCapua, Samuel K Cho
STUDY DESIGN: This is retrospective study of prospectively collected data. OBJECTIVE: To identify patient factors that are independently associated with prolonged length of stay (LOS) and readmission after posterior cervical fusion (PCF) utilizing a large national database. SUMMARY OF BACKGROUND DATA: A number of studies have investigated the morbidity and mortality after PCF; however, little is known about the factors that are associated with prolonged LOS and readmission, both of which incur increased costs for patients and hospitals...
February 23, 2017: Clinical Spine Surgery
Justin K Scheer, Joshua Bakhsheshian, Malla K Keefe, Virginie Lafage, Shay Bess, Themistocles S Protopsaltis, Douglas C Burton, Robert A Hart, Christopher I Shaffrey, Frank Schwab, Justin S Smith, Zachary A Smith, Tyler R Koski, Christopher P Ames
STUDY DESIGN: Multicenter prospective pilot study. OBJECTIVE: To evaluate if continuous physical activity monitoring by a personal electronic 3-dimensional accelerometer device is feasible and can provide objective data that correlates with patient-reported outcomes following spine surgery. SUMMARY OF BACKGROUND DATA: Self-reported health-related quality-of-life (HRQOL) metrics are inherently limited by being very subjective, having a low frequency of data collection, and inconsistent follow-up...
February 23, 2017: Clinical Spine Surgery
Ivo Peto, Christian Scheiwe, Evangelos Kogias, Ulrich Hubbe
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF). SUMMARY OF BACKGROUND DATA: Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach...
February 23, 2017: Clinical Spine Surgery
Abhishek Kumar, Robert K Merrill, Sheeraz A Qureshi
STUDY DESIGN: Cadaver study. OBJECTIVE: To investigate the safety of the extraforaminal lumbar interbody fusion approach. SUMMARY OF BACKGROUND DATA: Over the last decade the number of techniques available for lumbar interbody fusion has increased. Recent interest has developed in an extraforaminal approach to the intervertebral disc to reduce the morbidity associated with facetectomy. The safety of this extraforaminal corridor with regards to the exiting nerve root and lumbar plexus has yet to be assessed...
February 23, 2017: Clinical Spine Surgery
Alexander A Theologis, Michael Safaee, Justin K Scheer, Virginie Lafage, Rick Hostin, Robert A Hart, Eric O Klineberg, Themistocles S Protopsaltis, Vedat Deviren, Douglas C Burton, Daniel M Sciubba, Khaled Kebaish, Shay Bess, Christopher I Shaffrey, Frank Schwab, Justin S Smith, Christopher P Ames
STUDY DESIGN: This is a retrospective review of a prospective multicenter adult spinal deformity (ASD) database. OBJECTIVE: To quantify the location and magnitude of sagittal alignment changes within instrumented and noninstrumented spinal segments and to investigate the factors associated with these changes after surgery for ASD. SUMMARY OF BACKGROUND DATA: Spinal realignment is one of the major goals in ASD surgery and changes in the alignment are common following surgical correction...
February 20, 2017: Clinical Spine Surgery
Kyung-Soo Suk, Kyung-Chung Kang, Hak-Sun Kim, Seong-Hwan Moon, Hwan-Mo Lee, Jung-Ho Seo, Sung-Min Kim, Sung-Yub Jin, Pierre Mella
STUDY DESIGN: A retrospective study. OBJECTIVE: To identify preoperative risk factors causing cervical fifth nerve root palsy (C5 palsy) after laminectomy and fusion (LF). SUMMARY OF BACKGROUND DATA: It is well known that postoperative C5 palsy is not rare after cervical surgery. Although there remains controversy, C5 palsy is considered to be more common in patients who had LF than in those who had laminoplasty. However, the reason for the higher incidence of C5 palsy in patients with LF has been poorly understood...
February 20, 2017: Clinical Spine Surgery
Lei Wang, Dasheng Lin, Weitao Zou, Hui Liu, Kejian Lian
BACKGROUND: The semirigid pedicle screw instrumentation has gained wide popularity in recent decennium in lumbar fusion surgery. However, few data were documented to compare the clinical efficacy between semirigid and traditional rigid pedicle screw systems. MATERIALS AND METHODS: A total of 96 patients with degenerative lumbar diseases were selected to perform operations between 2008 and 2013. The patients were prospectively randomized into 2 groups: 50 patients were managed by semirigid waved rod systems and 46 patients were intervened by traditional rigid straight stiff rod systems...
February 17, 2017: Clinical Spine Surgery
Alok D Sharan, Gregory D Schroeder, Michael E West, Alexander R Vaccaro
The increasing awareness of the scarcity of health care resources is forcing the health care industry to improve quality while lowering the cost. One method by which employers and insurance companies are attempting to do this is with value-based insurance design. In these plans, patients pay a lower amount for certain services that are considered high value and a higher amount for services that are considered low value.
February 17, 2017: Clinical Spine Surgery
George N Rymarczuk, James S Harrop, Aaron Hilis, Roger Härtl
No abstract text is available yet for this article.
February 17, 2017: Clinical Spine Surgery
Bassel G Diebo, Cyrus M Jalai, Vincent Challier, Bryan J Marascalchi, Samantha R Horn, Gregory W Poorman, Olivia J Bono, Denis Cherkalin, Nancy Worley, Jason Oh, Qais Naziri, Allison Spitzer, Kris Radcliff, Ashish Patel, Virginie Lafage, Carl B Paulino, Peter G Passias
STUDY DESIGN: Retrospective review of the Nationwide Inpatient Sample from 2001 to 2010, a prospectively collected national database. OBJECTIVE: Structure an index to quantify adult spinal deformity (ASD) surgical risk based on risk factors for medical complications, surgical complications, revisions (R), mortality (M) rates, and length of hospital stay. SUMMARY OF BACKGROUND DATA: Evidence supporting ASD surgery cost-effectiveness and anticipating surgical risk is critical to evaluate the risk/benefit balance of such treatment for patients...
February 6, 2017: Clinical Spine Surgery
Areena R D'souza, Bibhudendu Mohapatra, Murari L Bansal, Kalidutta Das
STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the results of posterior pedicle-screw fixation with transpedicular decompression in 21 cases of thoracic and thoracolumbar spinal tuberculosis (TB) in terms of functional, neurological, and radiologic outcomes. SUMMARY OF BACKGROUND DATA: Spinal TB is predominantly an anterior disease that can lead to kyphotic deformity. Hence, anterior debridement and fusion was considered as the gold standard...
February 6, 2017: Clinical Spine Surgery
Alireza K Nazemi, Anirudh K Gowd, Jonathan J Carmouche, Stephen L Kates, Todd J Albert, Caleb J Behrend
STUDY DESIGN: This study is a systematic review. OBJECTIVE: Propose an evidence-based algorithm for prevention, diagnosis, and management of postoperative delirium in geriatric patients undergoing elective spine surgery. SUMMARY OF BACKGROUND DATA: Delirium is associated with longer stays after elective surgery, increased risk of readmission, and $6.9 billion annually in medical costs. Early diagnosis and treatment of delirium can reduce length of stay (LOS), in-hospital morbidity, and health care costs...
January 30, 2017: Clinical Spine Surgery
Benjamin P Rosenbaum, Michael T Modic, Ajit A Krishnaney
STUDY DESIGN: This is a retrospective study. OBJECTIVE: Compare improvements in health status measures (HSMs) and surgical costs to determine whether use of more costly items has any relationship to clinical outcome and value in lumbar disc surgery. SUMMARY OF BACKGROUND DATA: Association between cost, outcomes, and value in spine surgery, including lumbar discectomy is poorly understood. Outcomes were calculated as difference in mean HSM scores between preoperative and postoperative timeframes...
January 25, 2017: Clinical Spine Surgery
Takashi Hirai, Toshitaka Yoshii, Yoshiyasu Arai, Kenichiro Sakai, Ichiro Torigoe, Hidetsugu Maehara, Masaki Tomori, Takashi Taniyama, Hirokazu Sato, Atsushi Okawa
STUDY DESIGN: This is a retrospective observational single-center study. OBJECTIVES: To compare anterior decompression and fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM) patients with large anterior compression in terms of clinical and radiologic outcomes. SUMMARY OF BACKGROUND DATA: We have reported that insufficient posterior decompression could be often seen after laminoplasty for CSM patients with preoperative anterior clearance of the spinal cord, defined as an interval <4 mm between the preoperative the modified K-line and anterior structure of the spinal canal at most compressive segment on sagittal T1-weighted magnetic resonance imaging...
January 17, 2017: Clinical Spine Surgery
Ryan Khanna, Robert B Kim, Sandi K Lam, George R Cybulski, Zachary A Smith, Nader S Dahdaleh
STUDY DESIGN: Multicenter propensity score-adjusted retrospective cohort study. OBJECTIVE: To determine baseline 30-day complication rates for anterior cervical discectomy and fusion (ACDF) and compare clinical complications for patients undergoing single-level ACDFs between inpatient and outpatient settings. SUMMARY OF BACKGROUND DATA: ACDF remains the most common procedure in the treatment of a variety of cervical disc pathologies, making it a focus of quality improvement initiatives...
January 10, 2017: Clinical Spine Surgery
Nils H Ulrich, Jakob M Burgstaller, Ulrike Held, Sebastian Winklhofer, Mazda Farshad, Giuseppe Pichierri, Johann Steurer, François Porchet
STUDY DESIGN: This is prospective multicenter cohort study. OBJECTIVE: To assess whether patients with confirmed multisegmental lumbar spinal stenosis benefit more from a single-level or a multilevel decompression. SUMMARY OF BACKGROUND DATA: In multisegmental lumbar spinal stenotic cases, the decision as to how many levels of stenosis need to be operated to achieve the best possible clinical outcome is still unknown and remains a controversy between spine surgeons...
January 4, 2017: Clinical Spine Surgery
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