Regional variations in lumbar spine surgery in Finland

Abstract Introduction The regional variation in spine surgery rates has been shown to be large both within and between countries. This variation has been reported to be less in studies from countries with spine registers. The aim of this study was to describe the regional variation in lumbar spine surgery in Finland. Materials and methods This is a retrospective register study. Data from the Finnish National Hospital Discharge Register (NHDR) were used to calculate and compare the rates of lumbar disc herniation (LDH), decompression, and fusion surgeries in five University Hospital catchment areas, covering the whole Finnish population, from January 1, 1997, through December 31, 2018. Results A total of 138,119 lumbar spine operations (including LDH, decompression, and fusion surgery) were performed in Finland between 1997 and 2018. The regional differences in the rate of LDH surgery were over fourfold (18 vs. 85 per 100,000 person years), lumbar decompression surgery over threefold (41 vs. 129 per 100,000 person years), and lumbar fusion surgery over twofold (14 vs. 34 per 100,000 person years) in 2018. The mean age of the patients increased in all regions during the study period. Conclusions In Finland, the regional variations in spine surgeries were vast. In a country with a publicly funded healthcare system, this finding was surprising. The recently created national spine register may serve to shed more light on the reasons for this regional variation.

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A history of spine surgery predicts a poor outcome after hip arthroscopy

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz029 ◽

2019 ◽

Author(s):

Jacob D Feingold ◽

Braiden Heaps ◽

Sava Turcan ◽

Erica Swartwout ◽

Anil Ranawat

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Hip Arthroscopy ◽

Spine Fusion ◽

Harris Hip Score ◽

Lumbar Spine Surgery ◽

P Value ◽

Decompression Surgery ◽

Outcome Score ◽

The Difference

Abstract This study compared patient reported outcomes scores (PROMs) between patients undergoing hip arthroscopy who have and have not had previous lumbar spine surgery. We aimed to determine if prior spine surgery impacts the outcome of hip arthroscopy. Data were prospectively collected and retrospectively reviewed in patients who underwent hip arthroscopy between 2010 and 2017. Twenty cases were identified for analysis and matched to a control group. Four PROMs were collected pre-operatively and between 6 months and 2 years post-operatively (mean 16.2 months): Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sports) and the 33-item International Hip Outcome Tool (iHOT-33). Patients with previous spine surgery reported significantly worse (P-value <0.001) post-operative scores on all PROMs and smaller net changes on all PROMs with the difference on the mHHS (P-value 0.007), HOS-Sport (P-value 0.009) and iHOT-33 (P-value 0.007) being significant. Subsequent analyses revealed that the type of spine surgery matters. Patients with a spine fusion reported worse post-operative scores on all PROMs compared with patients with a spine decompression surgery with the difference on the mHHS (P-value 0.001), HOS-ADL (P-value 0.011) and HOS-Sport (P-value 0.035) being significant. Overall, patients with prior decompression surgery experienced considerable improvements from hip arthroscopy whereas patients with a prior spine fusion reported poor post-operative outcomes. Given these results, it is vital that hip preservation surgeons understand the impact of the lumbar spine on the outcome of hip arthroscopy.

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United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

Spine ◽

10.1097/01.brs.0000248132.15231.fe ◽

2006 ◽

Vol 31 (23) ◽

pp. 2707-2714 ◽

Cited By ~ 538

Author(s):

James N. Weinstein ◽

Jon D. Lurie ◽

Patrick R. Olson ◽

Kristen K. Bronner ◽

Elliott S. Fisher

Keyword(s):

United States ◽

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Regional Variations

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Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

Global Spine Journal ◽

10.1177/2192568220962435 ◽

2020 ◽

pp. 219256822096243

Author(s):

Hriday P. Bhambhvani ◽

Alex M. Kasman ◽

Chiyuan A. Zhang ◽

Serena S. Hu ◽

Michael L. Eisenberg

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Multivariable Analysis ◽

Thoracolumbar Spine ◽

Lumbar Spine Surgery ◽

Lumbar Interbody Fusion ◽

Delayed Ejaculation ◽

Institutional Experience

Study Design: Retrospective cohort. Objectives: Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine. Methods: We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE. Results: We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE. Conclusions: DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

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Intrathecal morphine in lumbar spine surgery: a novel injection technique

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.222 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S49-S50

Author(s):

GA Jewett ◽

D Yavin ◽

P Dhaliwal ◽

T Whittaker ◽

J Krupa ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Dural Puncture ◽

Intrathecal Morphine ◽

Lumbar Fusion ◽

Standard Of Care ◽

Csf Leak ◽

Lumbar Spine Surgery ◽

Injection Technique ◽

Csf Leakage

Background: Intrathecal morphine (ITM) is an efficacious method of providing post-operative analgesia. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. This may in part be attributed to concerns over precipitating a cerebrospinal fluid (CSF) leak following dural puncture. Methods: The dural sac is penetrated obliquely at a 30° angle to prevent overlap of dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. Participating spinal surgeons were provided with brief instructions outlining the injection technique. Adherence and complications were collected prospectively. Results: The technique was applied to 98 cases of elective lumbar fusion at our institution. Two cases (2.0%) of non-adherence followed pre-injection dural tear. 96 cases of oblique ITM injection resulted in no attributable instances of post-operative CSF leakage. Two cases (2.1%) of transient, self-limited CSF leakage immediately following ITM injection were observed without associated sequelae or requirement for further intervention. Conclusions: Oblique dural puncture is not associated with increased incidence of post-operative CSF leakage. This safe and reliable method of delivery of ITM should be routinely considered in lumbar spine surgery.

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Regional Variation in Opioid Use After Lumbar Spine Surgery

World Neurosurgery ◽

10.1016/j.wneu.2018.09.192 ◽

2019 ◽

Vol 121 ◽

pp. e691-e699 ◽

Cited By ~ 5

Author(s):

Owoicho Adogwa ◽

Mark A. Davison ◽

Victoria D. Vuong ◽

Shyam A. Desai ◽

Daniel T. Lilly ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Regional Variation ◽

Lumbar Spine Surgery ◽

Opioid Use

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Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

Asian Spine Journal ◽

10.4184/asj.2017.11.5.793 ◽

2017 ◽

Vol 11 (5) ◽

pp. 793-803 ◽

Cited By ~ 2

Author(s):

Yukitaka Nagamoto ◽

Shota Takenaka ◽

Hiroyuki Aono

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Confidence Interval ◽

Spine Surgery ◽

Odds Ratio ◽

Protective Factor ◽

Multivariate Logistic Regression Analysis ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Mr Images

<sec><title>Study Design</title>Retrospective case–control study</sec><sec><title>Purpose</title>To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.</sec><sec><title>Overview of Literature</title>Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.</sec><sec><title>Methods</title>We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.</sec><sec><title>Results</title>Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; <italic>p</italic><0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; <italic>p</italic>=0.002).</sec><sec><title>Conclusions</title>The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.</sec>

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Neurologic Disease Is a Risk Factor for Revision After Lumbar Spine Fusion

Global Spine Journal ◽

10.1177/2192568218821670 ◽

2019 ◽

Vol 9 (6) ◽

pp. 630-634 ◽

Cited By ~ 1

Author(s):

Steven D. Glassman ◽

Leah Y. Carreon ◽

John R. Dimar ◽

Jeffrey L. Gum ◽

Mladen Djurasovic

Keyword(s):

Risk Factor ◽

Lumbar Spine ◽

Spine Surgery ◽

Cox Regression ◽

Revision Rate ◽

Lumbar Fusion ◽

Lumbar Spine Surgery ◽

Neurologic Disorder ◽

Cox Regression Analysis ◽

Neurologic Disorders

Study Design: Medicare database analysis. Objective: The purpose of this study was to investigate whether neurologic disorders represent a risk factor for revision after lumbar spine surgery. Methods: Patients who underwent lumbar spine surgery were identified from 5% Medicare Part B claims between 2005 and 2008. Cox regression analysis was used to evaluate risk factors for revision within the 7 years after the index lumbar surgery. Covariates included age, gender, race, census region, Medicare buy-in status, Charlson score, year, prior lumbar fusion within 2 years of index surgery, prior diagnosis of cervical spondylotic myelopathy treated with or without cervical spine surgery, and diagnoses of other neuromuscular conditions. Results: Of 8665 cases who had decompression only, 401 (5%) had a revision within 7 years after the index surgery. Factors predictive of revision were prior lumbar fusion (hazard ratio [HR] = 2.78, confidence interval [CI] = 1.43-5.37, P = .002) and being female (HR = 1.61, CI = 1.31-1.97, P < .001). Of 5501 cases who had a decompression and fusion, 752 (14%) had a revision surgery within 7 years after the index surgery. Factors predictive of revision were the presence of a neurologic disorder (HR = 1.24, CI = 1.05-1.46, P = .010), prior lumbar fusion (HR = 3.09, CI = 2.05-4.63, P < .001), and being female (HR = 1.35, CI = 1.15-1.57, P < .001). Conclusions: An increase in revision rate ( P = 0.01, HR = 1.24) was seen in patients with neurologic disorders undergoing lumbar decompression and fusion, although not for patients undergoing decompression alone. This suggests an opportunity to improve clinical outcome and reduce revision rate through improved surgical decision making or treatment of the neurologic disorder.

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.7.spine16448 ◽

2017 ◽

Vol 26 (2) ◽

pp. 158-162 ◽

Cited By ~ 29

Author(s):

Ikemefuna Onyekwelu ◽

Steven D. Glassman ◽

Anthony L. Asher ◽

Christopher I. Shaffrey ◽

Praveen V. Mummaneni ◽

...

Keyword(s):

Back Pain ◽

Lumbar Spine ◽

Hospital Stay ◽

Clinical Outcomes ◽

Spine Surgery ◽

Lumbar Fusion ◽

Lumbar Spine Surgery ◽

Complication Rates ◽

Obese Patients ◽

Nonobese Patients

OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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The Effect of Parkinson’s Disease on Patients Undergoing Lumbar Spine Surgery

Parkinson s Disease ◽

10.1155/2018/8428403 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Jeremy Steinberger ◽

Jeffrey Gilligan ◽

Branko Skovrlj ◽

Christopher A. Sarkiss ◽

Javier Z. Guzman ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Fusion ◽

Multivariable Analysis ◽

Patient Characteristics ◽

Lumbar Spine Surgery ◽

Electrolyte Disorders ◽

Independent Risk Factors

Study Design. Retrospective Database Analysis. Objective. The purpose of this study was to assess characteristics and outcomes of patients with Parkinson’s disease (PD) undergoing lumbar spine surgery for degenerative conditions. Methods. The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on ICD-9-CM procedural codes for lumbar spine surgery and substratified to degenerative diagnoses. Incidence and baseline patient characteristics were determined. Multivariable analysis was performed to determine independent risk factors increasing incidence of lumbar fusion revision in PD patients. Results. PD patients account for 0.9% of all degenerative lumbar procedures. At baseline, PD patients are older (70.7 versus 58.9, p<0.0001) and more likely to be male (58.6% male, p<160.0001). Mean length of stay (LOS) was increased in PD patients undergoing lumbar fusion (5.1 days versus 4.0 days, p<0.0001) and lumbar fusion revision (6.2 days versus 4.8 days, p<180.0001). Costs were 7.9% (p<0.0001) higher for lumbar fusion and 25.2% (p<0.0001) higher for lumbar fusion revision in PD patients. Multivariable analysis indicates that osteoporosis, fluid/electrolyte disorders, blood loss anemia, and insurance status are significant independent predictors of lumbar fusion revision in patients with PD. Conclusion. PD patients undergoing lumbar surgery for degenerative conditions have increased LOS and costs when compared to patients without PD.

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Physiotherapy utilisation and costs before lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04129-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Joshua R. Zadro ◽

Adriane M. Lewin ◽

Priti Kharel ◽

Justine Naylor ◽

Christopher G. Maher ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Operative Management ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Workers Compensation ◽

South Wales ◽

Using Data ◽

Non Operative Management ◽

Time From Injury

Abstract Background Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. The aim of this study was to investigate physiotherapy utilisation and costs before lumbar spine surgery under a workers’ compensation claim in New South Wales (NSW), Australia. Methods Using data from the NSW State Insurance Regulatory Authority, we audited physiotherapy billing codes used before surgery for people who received lumbar spine surgery from 2010 to 2018. We summarised, separately for fusion and decompression, the time from initiation of physiotherapy to surgery, number of physiotherapy sessions people received before surgery, total cost of physiotherapy before surgery, and time from injury date to initiation of physiotherapy. All analyses were descriptive. Results We included 3070 people (800 had fusion, 2270 decompression). Mean age (standard deviation, SD) was similar between those who received fusion and decompression [42.9 (10.4) vs. 41.9 (11.6)]. Compared to people who had fusion, those who had decompression were more likely to not have any physiotherapy before surgery (28.4% vs. 15.4%), received physiotherapy for a shorter duration before surgery [median (interquartile range, IQR): 5 (3 to 11) vs. 15 (4–26) months], were less likely to have physiotherapy for ≥2 years before surgery (5.6% vs. 27.5%), had fewer physiotherapy sessions before surgery [mean (SD): 16 (21) vs. 28 (35) sessions], were less likely to have > 50 physiotherapy sessions before surgery (6.8% vs. 18.1%), and had lower total physiotherapy-related costs [mean (IQR): $1265 ($0–1808) vs. $2357 ($453–2947)]. Time from injury date to first physiotherapy session was similar between people who had fusion and decompression [median (IQR): 23 (9–66) vs.19 (7–53) days]. Conclusions There is variation in physiotherapy utilisation and costs before lumbar spine surgery for people funded by NSW Workers’ Compensation. Some people may not be receiving an adequate trial of physiotherapy before surgery, particularly before decompression surgery. Others may be receiving an excessive amount of physiotherapy before surgery, particularly before fusion.

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