In Response to “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

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43. Preoperative regional erector spinae plane blocks reduce opioid use, increase mobilization, and reduce length of stay following lumbar spine fusion

The Spine Journal ◽

10.1016/j.spinee.2020.05.146 ◽

2020 ◽

Vol 20 (9) ◽

pp. S21

Author(s):

Robert J Owen ◽

Darrel S. Brodke ◽

Noah Quinlan ◽

Brandon D. Lawrence ◽

W. Ryan Spiker ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Erector Spinae ◽

Opioid Use ◽

Lumbar Spine Fusion

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Patients Who Undergo Primary Lumbar Spine Fusion After Recent but Not Remote Total Hip Arthroplasty Are at Increased Risk for Complications, Revision Surgery, and Prolonged Opioid Use

World Neurosurgery ◽

10.1016/j.wneu.2020.08.210 ◽

2020 ◽

Vol 144 ◽

pp. e523-e532

Author(s):

Shyam A. Patel ◽

Neill Y. Li ◽

Daniel S. Yang ◽

Daniel B.C. Reid ◽

Kevin J. Disilvestro ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Spine Fusion ◽

Opioid Use ◽

Total Hip ◽

Lumbar Spine Fusion ◽

Increased Risk

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IMPACT OF BODY HABITUS ON PERIOPERATIVE MORBIDITY ASSOCIATED WITH FUSION OF THE THORACOLUMBAR AND LUMBAR SPINE

Neurosurgery ◽

10.1227/01.neu.0000350863.69524.8e ◽

2009 ◽

Vol 65 (3) ◽

pp. 490-498 ◽

Cited By ~ 52

Author(s):

Mohammed F. Shamji ◽

Stephen Parker ◽

Chad Cook ◽

Ricardo Pietrobon ◽

Christopher Brown ◽

...

Keyword(s):

Body Mass Index ◽

Logistic Regression ◽

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Multivariate Logistic Regression ◽

Body Habitus ◽

Perioperative Morbidity ◽

Lumbar Spine Fusion ◽

Transfusion Requirements

Abstract OBJECTIVE Spinal fusion is performed in patients ranging from young and healthy to aged and frail. Although recent population trends in the United States are toward obesity, no large-scale study has evaluated how body habitus affects mortality, complications, and resource utilization for lumbar spine fusion. Such information is important for patient selection and to confirm the safety of such procedures in this population. METHODS Data for 244 170 patients who underwent thoracolumbar or lumbar spine fusion for degenerative disease between 1988 and 2004 were collected from the Nationwide Inpatient Sample database, and subjects were grouped by surgical approach and body habitus. Multivariate logistic regression evaluated group effects on selected postoperative complications, length of stay, resource utilization, and discharge disposition. RESULTS This study confirms that body habitus affects perioperative morbidity sustained by patients undergoing thoracolumbar or lumbar spine fusion. Demographic heterogeneity exists for race, geography, and number of diseased levels among body habitus groups, prompting application of multivariate logistic regression for outcomes. For all approaches, higher body mass index associated with increased transfusion requirements and likelihood of discharge to assisted living. Furthermore, morbidly obese patients undergoing posterior fusion sustained more wound complications and postoperative infections. CONCLUSION This nationwide study describes inpatient complications encountered during fusion surgery in patients who are obese. For a given surgical approach, patients with higher body mass index sustain increased transfusion requirements and utilize more resources during thoracolumbar and lumbar spine fusion. Nevertheless, the findings of equivalent mortality, length of stay, and other complication rates suggest that patients who are obese remain safe surgical candidates.

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Postoperative “Rescue” Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases

Local and Regional Anesthesia ◽

10.2147/lra.s268973 ◽

2020 ◽

Vol Volume 13 ◽

pp. 95-98

Author(s):

Daniel N Kianpour ◽

Joseph T Gundy ◽

Jacob W Nadler ◽

Danielle M Lindenmuth

Keyword(s):

Lumbar Spine ◽

Spine Fusion ◽

Erector Spinae ◽

Lumbar Spine Fusion ◽

Erector Spinae Plane Block

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P75. Average costs, length of stay, and 30- and 90-day readmissions in obese and morbidly obese patients who undergo lumbar spine fusion

The Spine Journal ◽

10.1016/j.spinee.2020.05.473 ◽

2020 ◽

Vol 20 (9) ◽

pp. S182-S183

Author(s):

Xiao Chen ◽

Shane Shahrestani ◽

Andy Ton ◽

Alexander Ballatori ◽

Jeffrey C. Wang ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Morbidly Obese ◽

Obese Patients ◽

Lumbar Spine Fusion

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Degenerative Lumbar Spine Disease, Not Fusion, May Be a Risk Factor for Instability after Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719114 ◽

2020 ◽

Vol 4 (04) ◽

pp. 193-200

Author(s):

Daniel K. Witmer ◽

Evan R. Deckard ◽

R. Michael Meneghini

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Joint Disease ◽

Total Hip ◽

Female Sex ◽

Lumbar Spine Fusion ◽

Radiographic Measurements ◽

Acetabular Protrusio

AbstractDislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion have been reported as high as 20%. Few studies exist specifically for lumbar spine degenerative joint disease (DJD) and its relationship to THA instability. There were two study objectives: (1) report the incidence of lumbar spine DJD and previous lumbar spine fusion and (2) evaluate the relationship of these two conditions and other potential risk factors to postoperative dislocation after THA. We retrospectively reviewed 818 consecutive THAs performed by a single surgeon utilizing a posterior approach. Comprehensive medical chart and radiographic review was performed to identify patients with lumbar spine DJD and lumbar spine fusion. Radiographic measurements, patient factors, surgical factors, and incidences of dislocation also were recorded. Eight hundred and twelve THAs were analyzed. There were 10 dislocations (1.2%, 10/812). Lumbar spine DJD and previous lumbar spine fusion occurred in 33.4% (271/812) and 5.9% (48/812) of patients, respectively. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation using a Firth penalized maximum likelihood estimation specifically for rare events (area under receiver-operator characteristic curve = 0.91, 95% confidence interval 0.86, 0.96). Interestingly, only 2 of 10 dislocations had a previous lumbar spine fusion. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation, while lumbar spine fusion was largely unrelated. This study used data available to most practicing surgeons and provides useful information for counseling patients preoperatively.

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