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

2019 ◽  
Vol 9 (6) ◽  
pp. 630-634 ◽  
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.

scholarly journals Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

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.

scholarly journals Intrathecal morphine in lumbar spine surgery: a novel injection technique

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.

Fat Thickness as a Risk Factor for Infection in Lumbar Spine Surgery

Orthopedics ◽  
2016 ◽  
Vol 39 (6) ◽  
pp. e1124-e1128 ◽  
Author(s):  
John J. Lee ◽  
Khalid I. Odeh ◽  
Sven A. Holcombe ◽  
Rakesh D. Patel ◽  
Stewart C. Wang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Fat Thickness

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

2017 ◽  
Vol 26 (2) ◽  
pp. 158-162 ◽  
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.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
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.

scholarly journals Regional variations in lumbar spine surgery in Finland

2021 ◽  
Author(s):  
Heikki Mäntymäki ◽  
Ville T. Ponkilainen ◽  
Tuomas T. Huttunen ◽  
Ville M. Mattila
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Regional Variation ◽  
Lumbar Fusion ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Fusion Surgery ◽  
Regional Variations ◽  
National Hospital Discharge Register ◽  
Catchment Areas

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.

Risk Factor for Poor Patient Satisfaction After Lumbar Spine Surgery in Elderly Patients Aged Over 80 years

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tomohiro Hikata ◽  
Ken Ishii ◽  
Morio Matsumoto ◽  
Kazuyoshi Kobayashi ◽  
Shiro Imagama ◽  
...  
Keyword(s):  
Risk Factor ◽  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Elderly Patients ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Poor Patient ◽  
Surgery In Elderly

scholarly journals Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience

2017 ◽  
Vol 27 (6) ◽  
pp. 670-675 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Jessica Moreno ◽  
Joseph Cheng ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Perioperative Complications ◽  
Academic Medical Center ◽  
Nursing Home Admission ◽  
Lumbar Spine Surgery ◽  
The Mean

OBJECTIVEGeriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown.METHODSA unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes.RESULTSOne hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0.04). Compared with the non-POSH cohort, the majority of patients in the POSH cohort were discharged to home (24% vs 54%; p = 0.01).CONCLUSIONSGeriatric comanagement reduces the incidence of postoperative complications, shortens the duration of in-hospital stay, and contributes to improved perioperative functional status in elderly patients undergoing elective spinal surgery for the correction of adult degenerative scoliosis.

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