Radial Nerve Neuropraxis due to Compression by C-Arm Fluoroscopy in Spine Surgery: A Case Report

Introduction. Peripheral nerve injury is a well-known surgical complication related to the position of the patient. Moreover, in spine surgery, prone position for prolonged period places the patient at increased risk. The aim of this study was to report a case of a radial nerve neuropraxis due to compression by C-arm fluoroscopy during spine surgery. Case Presentation. An 81-year-old-female underwent a posterior spinal fixation L2-S1 due to lumbar spinal stenosis. In the recovery room, she presented an hematoma at the posterolateral part of her arm associated with a wrist drop due to radial nerve neuropraxis. The patient was referred to an occupational therapist and fully recovered four months later. After analysis of the patient positioning during the intervention, we came to the conclusion that this radial nerve injury was very possibly due to a compression by the C-arm fluoroscopy during the surgery. Conclusion. Our case describes a rare case of compression of the radial nerve during lumbar spine surgery, which is an unexpected complication as the site of the nerve injury is not at all related to the surgery itself, but to the position of the patient. Although C-arm fluoroscopy is essential, spine surgeons should be aware of this possible complication related to its use in order to avoid it.

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Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Global Spine Journal ◽

10.1177/2192568217694151 ◽

2017 ◽

Vol 7 (3) ◽

pp. 213-219 ◽

Cited By ~ 21

Author(s):

David N. Bernstein ◽

David Brodell ◽

Yue Li ◽

Paul T. Rubery ◽

Addisu Mesfin

Keyword(s):

United States ◽

Lumbar Spine ◽

Spine Surgery ◽

International Classification Of Diseases ◽

The United States ◽

Lumbar Spine Surgery ◽

Economic Downturn ◽

Classification Of Diseases ◽

Lumbar Spinal ◽

The Impact

Study Design: Retrospective database analysis. Objective: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. Methods: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. Results: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). Conclusions: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

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RADIAL NERVE INJURIES;

The Professional Medical Journal ◽

10.29309/tpmj/2008.15.01.2699 ◽

2008 ◽

Vol 15 (01) ◽

pp. 67-73

Author(s):

MAQSOOD UL HASSAN RASHEED ◽

ASHER AHMAD MASHHOOD ◽

MUHAMMAD RIAZ AKHTAR ◽

Muhammad Babar Khan

Keyword(s):

Nerve Injury ◽

Radial Nerve ◽

Armed Forces ◽

Rehabilitation Medicine ◽

Radial Nerve Palsy ◽

Early Referral ◽

Medicine Department ◽

Gun Shot ◽

Radial Nerve Injury ◽

Wrist Drop

Objective: To highlight etiological factors leading to radial nerve injury resulting in wrist drop, withparticular reference to iatrogenic causes. Design: Retrospection & Descriptive. Material & Methods: One hundredpatients of all ages and both sexes with wrist drop. Data of clinical assessment after detailed history and examinationas well as electro diagnostic studies was recorded on pre-designed assessment proforma. The outcome was charteddown for frequency of etiology of the wrist drop. Setting: Rehabilitation Medicine Department of Combined MilitaryHospital (CMH) Multan and Armed Forces Institute of Rehabilitation Medicine (AFIRM). Results: The major cause ofinjury was splinter/gun shot injury 31%, mis-placed injection at mid-arm 21%fracture of humerus was 21%, compressionneuropathy 16%, and stab wound 11%caused wrist drop. Electro-physiological studies revealed that 85% patients hadinjury to radial nerve at mid-arm, 9% had injury to posterior interosseous nerve while 4% had injury to superficial branchof radial nerve and only 2% had normal study. Electrodiagnostic studies also revealed that majority of the patientssuffered from axonotmesis (44%) and neurapraxia (38%), whereas (16%) were neurotmesis. Conclusion: The mostcommon cause of radial nerve injury is trauma. It is also found that the frequency of radial nerve palsy due to iatrogeniccauses is quite high. In addition to the clinical examination, the nerve conduction studies and electromyography provedto be the better investigation technique in the assessment of the location, severity and extent of the peripheral nerveinjury and subsequently guides in starting the proper treatment option due to early referral of patient to the concernedfields.

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Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

10.21203/rs.3.rs-1017167/v1 ◽

2021 ◽

Author(s):

frédérick rault ◽

Anaïs R Briant ◽

Thomas Gaberel ◽

Hervé Kamga ◽

Evelyne Emery

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Heart Diseases ◽

The Elderly ◽

Lumbar Spine Surgery ◽

Increased Risk ◽

History Of ◽

Lumbar Spinal

Abstract Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

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Nerve root herniation with entrapment in the facet joint gap after lumbar decompression surgery: a case presentation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04601-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Branko Popadic ◽

Florian Scheichel ◽

Melanie Themesl ◽

Ingo Decristoforo ◽

Camillo Sherif ◽

...

Keyword(s):

Spine Surgery ◽

Nerve Root ◽

Facet Joint ◽

Surgical Complication ◽

Decompression Surgery ◽

Case Presentation ◽

Lumbar Decompression ◽

Postoperative Mri ◽

Joint Gap ◽

Lumbar Decompression Surgery

Abstract Background An incidental dural tear is a well-known complication during spine surgery. A rare consequence is a postoperative nerve root herniation. The purpose of this report is to describe a case of such a herniation with entrapment in the facet gap joint and to present the first MR images of this rare surgical complication. Case presentation We report a case of a patient who underwent lumbar decompression surgery and afterwards suffered a sudden intractable sciatica. Postoperative MRI showed a new facet joint gap effusion. During revision surgery an entrapped nerve root was found in the facet joint gap. In retrospective, the herniated nerve root is visible on postoperative MRI. Conclusion This case report highlights a rare complication during spine surgery. This finding is important as signs suggestive for nerve root herniation can easily be overlooked on MRI. Furthermore, this represents the first MRI documentation of this complication.

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Unique Bone Suture Anchor Repair of Complex Lumbar Cerebrospinal Fluid Fistulas

Surgical Neurology International ◽

10.25259/sni_243_2020 ◽

2020 ◽

Vol 11 ◽

pp. 153

Author(s):

Marc Agulnick ◽

Benjamin R. Cohen ◽

Nancy E. Epstein

Keyword(s):

Cerebrospinal Fluid ◽

Lumbar Spine ◽

Spine Surgery ◽

Suture Anchor ◽

Hand Surgery ◽

Lumbar Spine Surgery ◽

Lumbar Spinal Surgery ◽

Lumbar Cerebrospinal Fluid ◽

Dural Tears ◽

Lumbar Spinal

Background: Spine surgeons encounter occasional complex cerebrospinal fluid fistulas/dural tears (CSF/DT) during lumbar spinal surgery. In some cases, these leaks are found during the index procedure, but others may appear postoperatively, or in the course of successive procedures. Here we asked, whether these complex CSF fistulas/DT could be more readily repaired utilizing a “bone suture anchor” technique, particularly where there is no residual dural margin/remnant. Methods: With the combined expertise of the orthopedist and neurosurgeon, mini/micro bone suture anchors, largely developed for hand surgery, facilitated repair of complex DT occurring during lumbar spine surgery. This technique was utilized to suture in place fascia, periosteal, or muscle grafts, and was followed by the application of microfibrillar collagen, and a fibrin sealant. Results: This mini/micro suture anchor technique has now been utilized to repair multiple significant intraoperative and/or postoperative recurrent DT, largely avoiding the need to place lumbar drains and/or lumbo- peritoneal shunts. Conclusions: Here, we reviewed how to directly suture dural grafts utilizing a mini/micro bone suture anchor technique to repair complex intraoperative primary/recurrent DT occurring during lumbar spine surgery. The major advantages of this technique, in addition to obtaining definitive occlusion of the DT, largely avoids the need to place lumbar drains and/or lumbo-peritoneal shunts with their attendant risks and complications.

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Risk Factors For Prolonged Opioid Use After Spine Surgery

Global Spine Journal ◽

10.1177/21925682211003854 ◽

2021 ◽

pp. 219256822110038

Author(s):

Christopher Kowalski ◽

Ryan Ridenour ◽

Sarah McNutt ◽

Djibril Ba ◽

Guodong Liu ◽

...

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Spine Surgery ◽

Pain Syndrome ◽

Lumbar Spine Surgery ◽

Opioid Use ◽

Chronic Regional Pain Syndrome ◽

Increased Risk ◽

Operative Complications ◽

Post Operative Complications

Study Design: Retrospective review. Objective: Our purpose was to evaluate factors associated with increased risk of prolonged post-operative opioid pain medication usage following spine surgery, as well as identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. Methods: The MarketScan commercial claims and encounters database includes approximately 39 million patients per year. Patients undergoing cervical and lumbar spine surgery between the years 2005-2014 were identified using CPT codes. Pre-operative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications, and diabetes were queried and documented. Patients who utilized opioids from 1-3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed pre- and post-operative narcotic medications up to 1 month prior to surgery. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. Results: 553,509 patients who underwent spine surgery during the 10-year period were identified. 34.9% of patients utilized opioids 1-3 months pre-operatively. 25% patients were still utilizing opioids at 6 weeks, 17.3% at 3 months, 12.7% at 6 months, and 9.0% at 1 year after surgery. Pre-operative opioid exposure was associated with increased likelihood of post-operative use at 6-12 weeks (OR 5.45, 95% CI 5.37-5.53), 3-6 months (OR 6.48, 95% CI 6.37-6.59), 6-12 months (OR 6.97, 95% CI 6.84-7.11), and >12 months (OR 7.12, 95% CI 6.96-7.29). Mental health diagnosis, tobacco usage, diagnosis of chronic pain or CRPS, and non-narcotic neuromodulatory medications yielded increased likelihood of prolonged post-op opioid usage. Conclusions: Pre-operative narcotic use and several patient comorbidities diagnoses are associated with prolonged post-operative opioid usage following spine surgery. Chronic opioid use, diagnosis of chronic pain, or use of non-narcotic neuromodulatory medications have the highest risk of prolonged post-operative opioid consumption. Patients using opiates pre-operatively did have an increased 30 and 90-day readmission risk, in addition to a number of serious post-operative complications. This data provides spine surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers, and payers with information on complications associated with pre-operative opioid utilization.

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Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations

Journal of Neurosurgery Spine ◽

10.3171/2012.10.spine12271 ◽

2013 ◽

Vol 18 (2) ◽

pp. 165-169 ◽

Cited By ~ 59

Author(s):

Yoshimasa Takahashi ◽

Tetsuro Sato ◽

Hironori Hyodo ◽

Tomomaro Kawamata ◽

Eiji Takahashi ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Spinal Canal ◽

Degenerative Spondylolisthesis ◽

Spinal Canal Stenosis ◽

Lumbar Spine Surgery ◽

Dural Tear ◽

Canal Stenosis ◽

Lumbar Spinal ◽

Incidental Durotomy

Object Incidental durotomy (dural tear) is a common complication of lumbar spine surgery. The purpose of this study was to clarify the anatomical location of and the specific causative factors for incidental durotomy during primary lumbar spine surgery. Methods The authors retrospectively reviewed 1014 consecutive cases involving patients (412 women and 602 men; mean age 57 years; age range 11–97 years) who underwent a surgical procedure for treatment of degenerative lumbar spinal disease at their institution between 2002 and 2008. In total, 1261 disc levels were treated surgically. Disease at the treated levels included 544 disc herniations, 453 instances of spinal canal stenosis without spondylolisthesis, 188 instances of lumbar spinal canal stenosis with spondylolisthesis (degenerative spondylolisthesis), 49 instances of combined stenosis (stenosis with disc herniation), and 22 juxtafacet cysts. In 5 of the treated levels, the condition was classified as “other” disease. Treatment included fenestration with discectomy in 547 levels, fenestration alone in 626, fenestration with resection of juxtafacet cysts in 22, unilateral recapping laminoplasty in 20, posterolateral spinal fusion or posterior lumbar interbody fusion in 17, microscopic discectomy with tubular retractor in 14, and “other” in 15. Results Unintended durotomy occurred in 4% of cases and in 3.3% of disc levels. The incidence of dural tear was significantly higher in women (5.6%) than in men (3%). The incidence of dural tear was 2% in disc levels with lumbar disc herniation, 1.8% with lumbar spinal canal stenosis without spondylolisthesis, 9% with degenerative spondylolisthesis, and 18.2% with juxtafacet cysts; the incidence was significantly higher in levels with degenerative spondylolisthesis or levels with juxtafacet cysts, than in those with other diseases. Incidental durotomy occurred in 4 critical anatomical zones, namely, the caudal margin of the cranial lamina, cranial margin of the caudal lamina, herniated disc level, and medial aspect of the facet joint adjacent to the insertion of the hypertrophic ligamentum flavum. Conclusions Risk factors for unintended durotomy were female sex, older age, degenerative spondylolisthesis, and juxtafacet cysts. In this study, the authors identified 4 high-risk anatomical zones that spine surgeons should be aware of to avoid dural tears.

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Perioperative Invasive Vascular Catheterization Associated With Increased Risk of Postoperative Infection in Lumbar Spine Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000751 ◽

2019 ◽

Vol 32 (3) ◽

pp. E145-E152

Author(s):

Edward Compton ◽

Patrick Heindel ◽

Blake Formanek ◽

Kyle Schoell ◽

Zorica Buser ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Postoperative Infection ◽

Lumbar Spine Surgery ◽

Increased Risk ◽

Vascular Catheterization

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Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study

10.21203/rs.2.19341/v1 ◽

2019 ◽

Author(s):

Sharada Weir ◽

Mihail Samnaliev ◽

Tzu-Chun Kuo ◽

Travis S. Tierney ◽

Andrea Manca ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Postoperative Pain ◽

Spine Surgery ◽

Spinal Surgery ◽

Healthcare Costs ◽

Lumbar Spine Surgery ◽

Failed Back Surgery ◽

Persistent Postoperative Pain ◽

Lumbar Spinal

Abstract Purpose. To compare rates of persistent postoperative pain (PPP) after lumbar spine surgery—commonly known as Failed Back Surgery Syndrome—and healthcare costs for instrumented lumbar spinal fusion versus decompression/discectomy. Methods. UK population-based healthcare data from the Hospital Episode Statistics (HES) database from NHS Digital and the Clinical Practice Research Datalink (CPRD) were queried to identify patients with PPP following lumbar spinal surgery. Rates of PPP were calculated by type of surgery (instrumented and non-instrumented). Total healthcare costs associated with the surgery and covering the 24 month period after index hospital discharge were estimated using standard methods for classifying health care encounters into major categories of health care resource utilization (i.e., inpatient hospital stays, outpatient clinic visits, accident and emergency attendances, primary care encounters, and medications prescribed in primary care) and applying the appropriate unit costs (expressed in 2013 GBP). Results. Increasing the complexity of surgery with instrumentation was not associated with an increased rate of PPP. However, 2-year healthcare costs following discharge after surgery are significantly higher among patients who underwent instrumented surgery compared with decompression/discectomy. Conclusions. Although there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within two years of surgery, the choice of surgical procedure does not, by itself, appear to be a driving factor.

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