Opioids delay healing of spinal fusion: a rabbit posterolateral lumbar fusion model

Abstract Objective: The goal of this study was to establish a rhBMP-2 induced posterolateral intertransverse lumbar fusion model in the mouse to serve as an acceptable substitute for models using larger animals, such as the rat, by defining the pertinent anatomy and establishing an effective dosing regimen in the mouse. Methods: Forty 10-week-old male Institute of Cancer Research (ICR) mice were randomized into five groups and were subjected to posterolateral lumbar fusion surgery at the L5-L6 level and received the following assigned treatment regimens: Group A: carrier collagen sponge only; Group B: 0.05μg rhBMP-2 on a collagen sponge; Group C: 0.15μg rhBMP-2 on a collagen sponge; Group D: 0.5μg rhBMP-2 on a collagen sponge; and Group E: 1.5μg rhBMP-2 on a collagen sponge. The study was ended at eight weeks post-operation and standard x-ray and micro-computed tomography imaging were performed in addition to histological examination of dissected spine specimens. Results: BMP-2 induced new bone at all dose levels in a dose-related manner. The mice implanted with rhBMP-2 at the dose of 0.5μg demonstrated more bone formation and a higher fusion rate compared to mice receiving lower doses. More abundant bone formation could be induced by higher dose regimen, which could also result in poorer bone quality. Conclusions: Posterolateral lumbar fusion at the L5-L6 level can be successfully accomplished in mice. The dose of 0.5μg of rhBMP-2 delivered on a collagen sponge appears to be the optimal regimen to produce the most satisfactory fusion results.

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Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective Quality Outcomes Database registry

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine20296 ◽

2020 ◽

Vol 33 (5) ◽

pp. 635-642

Author(s):

Joseph Laratta ◽

Leah Y. Carreon ◽

Avery L. Buchholz ◽

Andrew Y. Yew ◽

Erica F. Bisson ◽

...

Keyword(s):

Spinal Fusion ◽

Preoperative Diagnosis ◽

Rating Scale ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Quality Outcomes ◽

Medical Comorbidities ◽

Fusion Procedure ◽

Patient Reported

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14258 ◽

2014 ◽

Vol 21 (1) ◽

pp. 7-13 ◽

Cited By ~ 15

Author(s):

Zoher Ghogawala ◽

Daniel K. Resnick ◽

William C. Watters ◽

Praveen V. Mummaneni ◽

Andrew T. Dailey ◽

...

Keyword(s):

Lumbar Spine ◽

Functional Outcome ◽

Spinal Fusion ◽

Lumbar Fusion ◽

Minimum Clinically Important Difference ◽

Degenerative Disease ◽

Psychological State ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

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