RESUMO
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: The purpose of this study was to investigate whether preoperative depressive symptoms, measured by mental component score of the Short Form-12 survey (MCS-12), influence patient-reported outcome measurements (PROMs) following an anterior cervical discectomy and fusion (ACDF) surgery for cervical degeneration. SUMMARY OF BACKGROUND DATA: There is a paucity of literature regarding preoperative depression and PROMs following ACDF surgery for cervical degenerative disease. METHODS: Patients who underwent an ACDF for degenerative cervical pathology were identified. A score of 45.6 on the MCS-12 was used as the threshold for depression symptoms, and patients were divided into two groups based on this value: depression (MCS-12 ≤45.6) and nondepression (MCS-12 >45.6) groups. Outcomes including Neck Disability Index (NDI), physical component score of the Short Form-12 survey (PCS-12), and Visual Analogue Scale Neck (VAS Neck), and Arm (VAS Arm) pain scores were evaluated using independent sample t test, recovery ratios, percentage of patients reaching the minimum clinically important difference, and multiple linear regression - controlling for factors such as age, sex, and BMI. RESULTS: The depression group was found to have significantly worse baseline pain and disability than the nondepression group in NDI (Pâ<â0.001), VAS Neck pain (Pâ<â0.001), and VAS Arm pain (Pâ<â0.001) scores. Postoperatively, both groups improved to a similar amount with surgery based on the recovery ratio analysis. The depression group continued to have worse scores than the nondepression group in NDI (Pâ=â0.010), PCS-12 (Pâ=â0.026), and VAS Arm pain (Pâ=â0.001) scores. Depression was not a significant predictor of change in any PROMs based on regression analysis. CONCLUSION: Patients who presented with preoperative depression reported more pain and disability symptoms preoperatively and postoperatively; however, both groups achieved similar degrees of improvement. LEVEL OF EVIDENCE: 3.
Assuntos
Vértebras Cervicais/cirurgia , Depressão/epidemiologia , Discotomia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral , Discotomia/efeitos adversos , Discotomia/estatística & dados numéricos , Humanos , Cervicalgia/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Período Pré-Operatório , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do TratamentoRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Antibacterianos/uso terapêutico , Guias de Prática Clínica como Assunto , Fusão Vertebral , Infecção da Ferida Cirúrgica/prevenção & controle , HumanosRESUMO
STUDY DESIGN: Retrospective review of a prospectively maintained database. OBJECTIVE: Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS). SUMMARY OF BACKGROUND DATA: There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF). METHODS: A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1âmm) of the vertebra in relation to an adjacent "to be fused" level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS. RESULTS: A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups. CONCLUSION: Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology. LEVEL OF EVIDENCE: 3.
Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Fusão Vertebral , Espondilolistese/cirurgia , Adulto , Idoso , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Cervicalgia/etiologia , Período Pós-Operatório , Radiografia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
STUDY DESIGN: A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC). OBJECTIVE: This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC. SUMMARY OF BACKGROUND DATA: The role of an OSH for lumbar fusion procedures has not been defined. METHODS: A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates. RESULTS: A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7âminutes, Pâ<â0.001), total OR time (195.1 vs. 247.9âminutes, Pâ<â0.001), and postoperative LOS (2.61 vs. 3.73 days, Pâ<â0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, Pâ<â0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (Pâ<â0.001), total OR time (Pâ=â0.004), AACCI (Pâ<â0.001), current smokers (Pâ=â0.048), and number of decompressed levels (Pâ=â0.032) were independent predictors of LOS. CONCLUSION: Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients. LEVEL OF EVIDENCE: 3.
Assuntos
Procedimentos Cirúrgicos Eletivos , Vértebras Lombares/cirurgia , Fusão Vertebral , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Hospitais , Humanos , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
Over the last decade, several of the Food and Drug Administration-regulated investigational device exemption (IDE) trials have compared multiple cervical disk arthroplasty (CDA) devices to anterior cervical decompression and fusion (ACDF) showing comparable and even superior patient-reported outcomes. CDA has been an increasingly attractive option because of the positive outcomes and the motion-preserving technology. However, with the large burden that health care expenditures place on the economy, the focus is now on the value of treatment options. Cost-effectiveness studies assess value by evaluating both outcomes and cost, and recently several have been conducted comparing CDA and ACDF. The results have consistently shown that CDA is a cost-effective alternative, however, in comparison to ACDF the results remain inconclusive. The lack of incorporation of disease specific measures into health state utility values, the inconsistent methods of calculating cost, and the fact that a vast majority of the results have come from industry-sponsored studies makes it difficult to form a definitive conclusion. Despite these limitations, both procedures have proven to be safe, effective, and cost-efficient alternatives.
Assuntos
Artroplastia , Vértebras Cervicais/cirurgia , Substituição Total de Disco , Artroplastia/economia , Análise Custo-Benefício , Descompressão Cirúrgica/economia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fusão Vertebral/economia , Substituição Total de Disco/economia , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective cohort. OBJECTIVE: Determine the effect of duration of symptoms (DOS) on health-related quality of life (HRQOL) outcomes for patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA: The effect of DOS has not been extensively evaluated for cervical radiculopathy. METHODS: A retrospective analysis of patients who underwent an anterior cervical decompression and fusion for radiculopathy was performed. Patients were grouped based on DOS of less than 6 months, 6 months to 2 years, and more than 2 years and HRQOL outcomes were evaluated. RESULTS: A total of 216 patients were included with a mean follow-up of 16.0 months. There were 86, 61, and 69 patients with symptoms for less than 6 months, 6 months to 2 years, and more than 2 years, respectively. No difference in the absolute postoperative score of the patient reported outcomes was identified between the cohorts. However, in the multivariate analysis, radiculopathy for more than 2 years predicted lower postoperative Short Form-12 Physical Component Score (Pâ=â0.037) and Short Form-12 Mental Component Score (Pâ=â0.029), and higher postoperative Neck Disability Index (Pâ=â0.003), neck pain (Pâ=â0.001), and arm pain (Pâ=â0.004) than radiculopathy for less than 6 months. Furthermore, the recovery ratios for patients with symptoms for less than 6 months demonstrated a greater improvement in NDI, neck pain, and arm pain than for 6 months to 2 years (Pâ=â0.041; 0.005; 0.044) and more than 2 years (Pâ=â0.016; 0.014; 0.002), respectively. CONCLUSION: Patients benefit from spine surgery for cervical radiculopathy at all time points, and the absolute postoperative score for the patient reported outcomes did not vary based on the duration of symptoms; however, the regression analysis clearly identified symptoms for more than 2 years as a predictor of worse outcomes, and the recovery ratio was statistically significantly improved in patients who underwent surgery within 6 months of the onset of symptoms. LEVEL OF EVIDENCE: 3.
Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Radiculopatia , Fusão Vertebral , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/estatística & dados numéricos , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Radiculopatia/epidemiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do TratamentoRESUMO
STUDY DESIGN: A retrospective review. OBJECTIVE: The purpose of this study is to determine the differential improvement of the various individual items of the Oswestry Disability Index (ODI) and to determine their relationship to other measures of Health Related Quality of Life (HRQOL). SUMMARY OF BACKGROUND DATA: The ODI is an easily scored, common, 10-item questionnaire about symptoms relevant to lumbar spine pathology. It is not clear if all of the items can be reliably applied to spine surgery. The purpose of this study is to determine the differential improvement of the various individual items of the ODI and to determine their relationship to other measures of HRQOL. METHODS: Analysis of a prospective registry of patients treated at an academic medical center was undertaken. At baseline, standardized outcome measures including ODI and SF12 PCS were collected on all patients undergoing elective fusion surgery for degenerative spondylolisthesis. Multiple linear regressions were performed using change in SF12 PCS as the dependent variable and change in ODI components as the independent variables. RESULTS: Baseline and 1-year follow-up data were collected on 196 patients (mean age 60.4 years). There were statistically significant differences in improvement among ODI items. Surprisingly, the most improvement after surgery was noted in the standing, sex life, and social life domains. The least improvement was noted in the personal care, sleeping, and sitting domains. Linear regression for change in ODI components versus change in SF-12 PCS revealed a significant correlation (Râ=â0.353, Pâ≤â0.001). The only retained domains in the final model were change in lifting, standing, and traveling as predictors for ΔPCS. CONCLUSION: All domains of the ODI do not improve equally after surgery for degenerative spondylolisthesis. Some of the domains that improve most (e.g., sex life) have no discernible relationship to the known pathophysiology of degenerative spondylolisthesis. Based upon these results, we conclude that the item bank and composite scoring of the ODI are inappropriate for evaluating quality of life in studies of surgically treated degenerative spondylolisthesis patients. LEVEL OF EVIDENCE: 3.