Identifying subsets of patients with single-level degenerative disc disease for lumbar fusion: the value of prognostic tests in surgical decision making

Study Design: Uncontrolled retrospective observational study. Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. Results: Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being “somewhat” or “extremely” satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. Conclusions: Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.

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Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: a prospective study in patients with single-level cervical degenerative disc disease

Journal of Translational Medicine ◽

10.1186/s12967-020-02688-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ce Zhu ◽

Miaomiao He ◽

Lili Mao ◽

Tao Li ◽

Li Zhang ◽

...

Keyword(s):

Degenerative Disc Disease ◽

Fusion Rate ◽

Peek Cage ◽

Disc Disease ◽

Degenerative Disc ◽

Single Level ◽

Cervical Degenerative Disc Disease ◽

Post Operation

Abstract Background Currently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD). Methods Twenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores. Results There was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively. Conclusions In patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

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Cochrane in CORR ® : Arthroplasty Versus Fusion in Single-level Cervical Degenerative Disc Disease

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-013-3284-0 ◽

2013 ◽

Vol 472 (3) ◽

pp. 802-808 ◽

Cited By ~ 2

Author(s):

Nathan Evaniew ◽

Kim Madden ◽

Mohit Bhandari

Keyword(s):

Degenerative Disc Disease ◽

Disc Disease ◽

Degenerative Disc ◽

Single Level ◽

Cervical Degenerative Disc Disease

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Sagittal alignment assessment after short-segment lumbar fusion for degenerative disc disease

International Orthopaedics ◽

10.1007/s00264-018-4222-2 ◽

2018 ◽

Vol 43 (4) ◽

pp. 891-898 ◽

Cited By ~ 4

Author(s):

Farzam Vazifehdan ◽

Vasilios G. Karantzoulis ◽

Vasilios G. Igoumenou

Keyword(s):

Degenerative Disc Disease ◽

Sagittal Alignment ◽

Lumbar Fusion ◽

Disc Disease ◽

Short Segment ◽

Degenerative Disc

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Differences in 30- and 90-Day Readmission Rates After Surgical Treatment for Lumbar Degenerative Disc Disease in Elderly Patients (³ð65 Years): A National Readmission Database Study

Neurosurgery ◽

10.1093/neuros/nyz310_629 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Aladine A Elsamadicy ◽

Andrew B Koo ◽

Megan Lee ◽

Adam Kundishora ◽

Joaquin Q Camara-Quintana ◽

...

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Degenerative Disc Disease ◽

Postoperative Infection ◽

Lumbar Fusion ◽

The Elderly ◽

Disc Disease ◽

Readmission Rates ◽

Posterior Lumbar Fusion ◽

Degenerative Disc

Abstract INTRODUCTION For spine surgery performed for degenerative disc disease (DDD), a paucity of nationwide studies exists describing common complications and readmission rates. The aim of this study was to investigate the differences and complications associated with 30- and 90-d readmissions following surgical treatment for lumbar DDD in the elderly. METHODS The Nationwide Readmission Database years 2013 to 2015 was queried. Elderly patients (>65 yr old) undergoing anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLIF)/posterolateral lumbar fusion (PLF), or anterior and posterior lumbar fusion (APLF) for lumbar DDD were identified. Unique patient linkage numbers were used to follow patients and identify 30- and 31 to 90-d readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 d (30-R), and readmission within 31 to 90 d (90-R). RESULTS We identified 11 651 elderly patients undergoing ALIF, PLIF/PLF, or APLF for lumbar DDD, with 1213 (10.4%) patients encountering a readmission (30-R: n = 812[7.0%]; 90-R: n = 401[3.4%]; Non-R: n = 10 438). The greatest proportion of each cohort had 2 to 3 vertebral levels fused (30-R: 63.7%, 90-R: 69.2%, Non-R: 70.2%). Iliac crest bone graft was the most common fusion agent used (30-R: 59.9%, 90-R: 51.4%, Non-R: 53.5%), followed by bone morphogenetic protein (30-R: 24.6%, 90-R: 22.9%, Non-R: 21.2%). The most common inpatient complications observed were acute posthemorrhagic anemia (30-R: 26.6%, 90-R: 22.3%, Non-R: 18.2%), postoperative infection (30-R: 6.2%, 90-R: 9.7%, Non-R: 3.5%), and genitourinary complication (30-R: 7.7%, 90-R: 2.7%, Non-R: 3.5%). The most prevalent 30- and 90-d complications seen among the readmitted cohort were postoperative infection (30-R: 18.7%, 90-R: 8.9%), device complications (30-R: 5.2%, 90-R: 9.1%), and sepsis (30-R: 6.9%, 90-R: 4.9%). On multivariate regression analysis, obesity, chronic pulmonary disease, smoking, and any complication during index admission were independently associated with 30-d readmission; private insurance and coagulopathy were independently associated with 90-d readmission. CONCLUSION Our study suggests that 30- and 90-d readmissions for treatment of lumbar DDD in the elderly are common, and that multiple patient-level factors independently predict hospital readmission.

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