Posterior spinal instrumented fusion and decompression.
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ABSTRACT:
SUBMITTER: Nunez S
PROVIDER: S-EPMC7571622 | biostudies-literature | 2010 Mar
REPOSITORIES: biostudies-literature
Publications
Posterior spinal instrumented fusion and decompression.
Nuñez Susana S Bagó Juan J Pellisé Ferran F
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 20100301 3
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Project description:BackgroundAcute spinal subdural haematoma (ASSH) is a rare and potentially devastating condition with a variable prognosis. Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery, spinal puncture or epidural anaesthesia. Other contributing pathologies have been described, such as intradural tumours or spinal arteriovenous malformations. ASSH has also been associated with anticoagulation therapy, haemostatic abnormalities and risk factors such as pregnancy. To the best of our knowledge, this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient. The patient was not known to have any coagulopathies, and no obvious vascular lesions were documented. The surgical procedure did not directly involve the dura mater, and no evident intraoperative dural tears were found.Case summaryWe reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis. This condition has not been previously described. We made recommendations for facing such an occurrence, explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol. We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders. We reviewed recommendations regarding neuromonitoring and treatment management in such cases.ConclusionASSH is a rare complication of posterior spinal instrumented fusion. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.
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| S-EPMC11224786 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) after spinal fusion is a significant morbidity that can lead to poor post-surgical outcomes. Identifying AKI risk factors and developing a risk model can raise surgeons' awareness and allow them to take actions to mitigate the risks. The objective of the current study is to develop machine learning (ML) models to assess patient risk factors predisposing to AKI after posterior spinal instrumented fusion.MethodsData was collected from the IBM MarketScan Database (2009-2021) for patients >18 years old who underwent spinal fusion with posterior instrumentation (3-6 levels). AKI incidence (defined by the International Classification of Diseases codes) was recorded 90-day post-surgery. Risk factors for AKI were investigated and compared through several ML models including logistic regression, linear support vector machine (LSVM), random forest, extreme gradient boosting (XGBoost), and neural networks.ResultsAmong the 141,697 patients who underwent fusion with posterior instrumentation (3-6 levels), the overall rate of 90-day AKI was 2.96%. We discovered that the logistic regression model and LSVM demonstrated the best predictions with area under the curve (AUC) values of 0.75. The most important AKI prediction features included chronic renal disease, hypertension, diabetes mellitus ± complications, older age (>50 years old), and congestive heart failure. Patients who did not have these five key risk factors had a 90-day AKI rate of 0.29%. Patients who had an increasing number of key risk factors subsequently had higher risks of postoperative AKI.ConclusionsThe analysis of the data with different ML models identified 5 key variables that are most closely associated with AKI: chronic renal disease, hypertension, diabetes mellitus ± complications, older age (>50 years old), and congestive heart failure. These variables constitute a simple risk calculator with additive odds ratio ranging from 3.38 (1 risk factor) to 91.10 (5 risk factors) over 90 days after posterior spinal fusion surgery. These findings can help surgeons risk-stratify their patients for AKI risk, and potentially guide post-operative monitoring and medical management.
| S-EPMC11467292 | biostudies-literature
Project description:This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and those who had not (group 2, n = 1040). We recorded and analyzed their baseline characteristics, their underlying comorbidities, and the details of their current instrumented spinal fusion. The incidences of new VC and screw loosening were recorded. In groups 1 and 2, the incidences of new VC were 31.8% and 22.7%, respectively, and those of new VC with screw loosening were 25.6% and 33%, respectively. The risk factor was upper screw level at the thoracolumbar junction (hazard ratio [HR] = 2.181, 95% confidence interval [CI]: 1.135-4.190) with previous VCF. The risk factors were age ≥ 80 years (HR = 1.782, 95% CI: 1.132-2.805), instrumented levels > 4 (HR = 1.774, 95% CI: 1.292-2.437), and peptic ulcer (HR = 20.219, 95% CI: 2.262-180.731) without previous VCF. Clinicians should closely monitor new VC after posterior instrumented spinal fusion in elderly patients with previous VCF with upper screw level at the thoracolumbar junction and in patients without previous VCF aged ≥ 80 years, with instrumented levels > 4 and peptic ulcer.
| S-EPMC9646654 | biostudies-literature
Project description:PurposeSurgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion.MethodsWe retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author's assessment of infection risk factors.ResultsA total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT.ConclusionsProphylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion.
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Project description:ImportanceConflicting evidence and large practice variation are present in the surgical treatment of degenerative spondylolisthesis. More than 90% of surgical procedures in the United States include instrumented fusion compared with 50% or less in other countries.ObjectiveTo evaluate whether the effectiveness of microdecompression alone is noninferior to decompression with instrumented fusion in a real-world setting.Design, setting, and participantsThis multicenter comparative effectiveness study with a noninferiority design assessed prospective data from the Norwegian Registry for Spine Surgery. From September 19, 2007, to December 21, 2015, 1376 patients at 35 Norwegian orthopedic and neurosurgical departments underwent surgery for lumbar spinal stenosis with degenerative spondylolisthesis without scoliosis. After excluding patients undergoing laminectomy alone, fusion without instrumentation, or surgery in more than 2 levels and those with a former operation at the index level, 794 patients were included in the analyses, regardless of missing or incomplete follow-up data, before propensity score matching. Data were analyzed from March 20 to October 30, 2018.ExposuresMicrodecompression alone or decompression with instrumented fusion.Main outcomes and measuresA reduction from baseline of 30% or greater in the Oswestry Disability Index at 12-month follow-up.ResultsAfter propensity score matching, 570 patients (413 female [72%]; mean [SD] age, 64.7 [9.5] years) were included for comparison, with 285 undergoing microdecompression (mean [SD] age, 64.6 [9.8] years; 205 female [72%]) and 285 undergoing decompression with instrumented fusion (mean [SD] age, 64.8 [9.2] years; 208 female [73%]). The proportion of each type of procedure varied between departments. However, changes in outcome scores varied within patients but not between departments. The proportion of patients with improvement in the Oswestry Disability Index of at least 30% was 150 of 219 (68%) in the microdecompression group and 155 of 215 (72%) in the instrumentation group. The 95% CI (-12% to 5%) for the difference of -4% was above the predefined margin of noninferiority (-15%). Microdecompression alone was associated with shorter operation time (mean [SD], 89 [44] vs 180 [65] minutes; P < .001) and shorter hospital stay (mean [SD], 2.5 [2.4] vs 6.4 [3.0] days; P < .001).Conclusions and relevanceAmong patients with degenerative spondylolisthesis, the clinical effectiveness of microdecompression alone was noninferior to that of decompression with instrumented fusion. Microdecompression alone was also associated with shorter durations of surgery and hospital stay, supporting the suggestion that the less invasive procedure should be considered for most patients.
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Project description:It is unclear whether using artificial cages increases fusion rates compared with use of bone chips alone in posterior lumbar interbody fusion for patients with lumbar spondylolisthesis. We hypothesized artificial cages for posterior lumbar interbody fusion would provide better clinical and radiographic outcomes than bone chips alone. We assumed solid fusion would provide good clinical outcomes. We clinically and radiographically followed 34 patients with spondylolisthesis having posterior lumbar interbody fusion with mixed autogenous and allogeneic bone chips alone and 42 patients having posterior lumbar interbody fusion with implantation of artificial cages packed with morselized bone graft. Patients with the artificial cage had better functional improvement in the Oswestry disability index than those with bone chips alone, whereas pain score, patient satisfaction, and fusion rate were similar in the two groups. Postoperative disc height ratio, slip ratio, and segmental lordosis all decreased at final followup in the patients with bone chips alone but remained unchanged in the artificial cage group. The functional outcome correlated with radiographic fusion status. We conclude artificial cages provide better functional outcomes and radiographic improvement than bone chips alone in posterior lumbar interbody fusion for lumbar spondylolisthesis, although both techniques achieved comparable fusion rates.Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Project description:PurposeFollowing surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS.MethodsAn observational cohort study was conducted using data from the British Spine Registry (2017-2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed.Results14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome.ConclusionOlder age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.
| S-EPMC8550110 | biostudies-literature