Dynamic stabilization adjacent to single-level fusion: Part I. Biomechanical effects on lumbar spinal motion

Object There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes. Methods An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level fusion for spondylolisthesis or single-level lumbar discectomy were included. The 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: lumbar disc (125 patients) and lumbar listhesis (35 patients). The quality-adjusted life year (QALY) data were calculated using 6-dimension utility index scores. Direct costs and complication costs were estimated using Medicare reimbursement values from 2011, and indirect costs were estimated using the human capital approach with the 2011 US national wage index. Total costs equaled $14,980 for lumbar discectomy and $43,852 for surgery for lumbar spondylolisthesis. Results There were 198 patients enrolled over 1 year. The mean age was 46 years (49% female) for lumbar discectomy (n = 148) and 58.1 years (60% female) for lumbar spondylolisthesis (n = 50). Ten patients with disc herniation (6.8%) and 1 with listhesis (2%) required repeat operation at 1 year. The overall 1-year follow-up rate was 88%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, visual analog scale, and SF-36 scores (p = 0.0002), which persisted at the 1-year evaluation (p < 0.0001). By 1 year, more than 80% of patients in each cohort who were working preoperatively had returned to work. Lumbar discectomy was associated with a gain of 0.225 QALYs over the 1-year study period ($66,578/QALY gained). Lumbar spinal fusion for Grade I listhesis was associated with a gain of 0.195 QALYs over the 1-year study period ($224,420/QALY gained). Conclusions This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. These data are useful for demonstrating return to work and cost-effectiveness following surgical treatment of single-level lumbar disc herniation or spondylolisthesis. One-year cost per QALY was obtained, and this cost per QALY is expected to improve further by 2 years. This work sets the stage for real-world analysis of the value of health interventions.

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Dynamic stabilization adjacent to single-level fusion: Part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up

European Spine Journal ◽

10.1007/s00586-010-1517-4 ◽

2010 ◽

Vol 19 (12) ◽

pp. 2181-2189 ◽

Cited By ~ 50

Author(s):

Michael Putzier ◽

Eike Hoff ◽

Stephan Tohtz ◽

Christian Gross ◽

Carsten Perka ◽

...

Keyword(s):

Clinical Benefit ◽

Dynamic Stabilization ◽

Single Level ◽

Adjacent Segments ◽

Level Fusion

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Intuitive assessment of modeled lumbar spinal motion by clustering and visualization of finite helical axes

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2021.104528 ◽

2021 ◽

pp. 104528

Author(s):

Robert RockenfellerCor ◽

Maria Hammer ◽

Julia Riede ◽

Syn Schmitt ◽

Kai Lawonn

Keyword(s):

Spinal Motion ◽

Lumbar Spinal

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Factors Associated with Conversion from Conservative to Surgical Treatment in Single-Level Lumbar Spinal Stenosis Patients

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2018.25.4.168 ◽

2018 ◽

Vol 25 (4) ◽

pp. 160

Author(s):

Young-Joon Ahn ◽

Se-Hyuk Im ◽

Byung-Kyu Park

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Single Level ◽

Factors Associated ◽

Lumbar Spinal

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The effect of ketoprophen on lumbar spinal fusion healing in a rabbit model

Journal of Neurosurgery Spine ◽

10.3171/spi-07/12/631 ◽

2007 ◽

Vol 7 (6) ◽

pp. 631-636 ◽

Cited By ~ 11

Author(s):

Julio Urrutia ◽

Rodrigo Mardones ◽

Felipe Quezada

Keyword(s):

Spinal Fusion ◽

Rabbit Model ◽

Fusion Rate ◽

Autologous Bone Graft ◽

Inhibitory Effect ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs ◽

Single Level ◽

Solid Fusion ◽

Lumbar Spinal

Object Several reports have shown that nonsteroidal antiinflammatory drugs (NSAIDs) have an inhibitory effect in osteogenesis and reduce heterotopic ossification in humans. A deleterious effect of NSAIDs in posterolateral intertransverse process fusion has also been suggested. The authors used a validated rabbit model to try to determine the influence of the NSAID ketoprophen on the fusion rate in lumbar spinal arthrodesis. Methods Thirty New Zealand male rabbits underwent posterolateral (intertransverse process) bilateral spinal fusions at a single level, using autologous bone graft obtained from both iliac crests. The animals were randomized after the operation, so that 15 rabbits received ketoprophen as a postoperative analgesic and the other 15 received the postoperative analgesic tramadol. The animals were killed 8 weeks after surgery, and fusion status was determined by inspection, palpation, anteroposterior radiographs, and histological analysis. Results A solid fusion was obtained in eight rabbits (53%), and pseudarthrosis in seven rabbits (47%) in each group. Conclusions These findings suggest that the use of ketoprophen after intertransverse spinal fusion at a single level does not decrease the fusion rate, compared with tramadol.

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The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Journal of Neurosurgery Spine ◽

10.3171/2013.7.spine1362 ◽

2013 ◽

Vol 19 (5) ◽

pp. 555-563 ◽

Cited By ~ 16

Author(s):

Zoher Ghogawala ◽

Christopher I. Shaffrey ◽

Anthony L. Asher ◽

Robert F. Heary ◽

Tanya Logvinenko ◽

...

Keyword(s):

Disc Herniation ◽

Patient Reported Outcome ◽

Lumbar Discectomy ◽

Cooperative Research ◽

Single Level ◽

Sf 36 ◽

Patient Reported ◽

Lumbar Spondylolisthesis ◽

Level Fusion

Object There is significant practice variation and considerable uncertainty among payers and other major stakeholders as to whether many surgical treatments are effective in actual US spine practice. The aim of this study was to establish a multicenter cooperative research group and demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures using prospectively collected patient-reported outcome measures. Methods An observational prospective cohort study was conducted at 13 US academic and community sites. Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis were included. Patients completed the 36-item Short-Form Survey Instrument (SF-36), Oswestry Disability Index (ODI), and visual analog scale (VAS) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: 125 patients with lumbar disc herniation, and 35 with lumbar spondylolisthesis. All patient data were entered into a secure Internet-based data management platform. Results Of 249 patients screened, there were 198 enrolled over 1 year. The median age of the patients was 45.0 years (49% female) for lumbar discectomy (n = 148), and 58.0 years (58% female) for lumbar spondylolisthesis (n = 50). At 30 days, 12 complications (6.1% of study population) were identified. Ten patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis required reoperation. The overall follow-up rate for the collection of patient-reported outcome data over 1 year was 88.3%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, VAS, and SF-36 scores (p ≤ 0.0002), which persisted over the 1-year follow-up period (p < 0.0001). By the 1-year follow-up evaluation, more than 80% of patients in each cohort who were working preoperatively had returned to work. Conclusions It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice. Clinical trial registration no.: 01220921 (ClinicalTrials.gov).

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