Commentary: Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity

OBJECTIVE This study assesses how degree of overlap, either before or after the critical operative portion, affects lumbar fusion outcomes. METHODS The authors retrospectively studied 3799 consecutive patients undergoing single-level, posterior-only lumbar fusion over 6 years (2013–2019) at a university health system. Outcomes recorded within 30–90 and 0–90 postoperative days included emergency department (ED) visit, readmission, reoperation, overall morbidity, and mortality. Furthermore, morbidity and mortality were recorded for the duration of follow-up. The amount of overlap that occurred before or after the critical portion of surgery was calculated as a percentage of total beginning or end operative time. Subsequent to initial whole-population analysis, coarsened exact-matched cohorts of patients were created with the least and most amounts of either beginning or end overlap. Univariate analysis was performed on both beginning and end overlap exact-matched cohorts, with significance set at p < 0.05. RESULTS Equivalent outcomes were observed when comparing exact-matched patients. Among the whole population, the degree of beginning overlap was correlated with reduced ED visits within 30–90 and 0–90 days (p = 0.007, p = 0.009; respectively), and less 0–90 day morbidity (p = 0.037). Degree of end overlap was correlated with fewer 30–90 day ED visits (p = 0.015). When comparing only patients with overlap, degree of beginning overlap was correlated with fewer 0–90 day reoperations (p = 0.022), and no outcomes were correlated with degree of end overlap. CONCLUSIONS The degree of overlap before or after the critical step of surgery does not lead to worse outcomes after lumbar fusion.

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Overlapping single-level lumbar fusion and adverse short-term outcomes

Journal of Neurosurgery Spine ◽

10.3171/2020.12.spine201861 ◽

2021 ◽

pp. 1-12

Author(s):

Ali S. Farooqi ◽

Donald K. E. Detchou ◽

Gregory Glauser ◽

Krista Strouz ◽

Scott D. McClintock ◽

...

Keyword(s):

Lumbar Fusion ◽

Demographic Data ◽

Univariate Analysis ◽

P Value ◽

Matched Cohort ◽

Short Term ◽

Single Level ◽

Significant Difference ◽

Duration Of Surgery ◽

The Impact

OBJECTIVE There is a paucity of research on the safety of overlapping surgery. The purpose of this study was to evaluate the impact of overlapping surgery on a homogenous population of exactly matched patients undergoing single-level, posterior-only lumbar fusion. METHODS The authors retrospectively analyzed case data of 3799 consecutive adult patients who underwent single-level, posterior-only lumbar fusion during a 6-year period (June 7, 2013, to April 29, 2019) at a multihospital university health system. Outcomes included 30-day emergency department (ED) visit, readmission, reoperation, and morbidity and mortality following surgery. Thereafter, coarsened exact matching was used to match patients with and without overlap on key demographic factors, including American Society of Anesthesiologists (ASA) class, Charlson Comorbidity Index (CCI) score, sex, and body mass index (BMI), among others. Patients were subsequently matched by both demographic data and by the specific surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographically matched cohort, and the surgeon-matched cohort, with significance set at a p value < 0.05. RESULTS There was no significant difference in morbidity or any short-term outcome, including readmission, reoperation, ED evaluation, and mortality. Among the demographically matched cohort and surgeon-matched cohort, there was no significant difference in age, sex, history of prior surgery, ASA class, or CCI score. Overlapping surgery patients in both the demographically matched cohort and the matched cohort limited by surgeon had longer durations of surgery (p < 0.01), but no increased morbidity or mortality was noted. Patients selected for overlap had fewer prior surgeries and lower ASA class and CCI score (p < 0.01). Patients with overlap also had a longer duration of surgery (p < 0.01) but not duration of closure. CONCLUSIONS Exactly matched patients undergoing overlapping single-level lumbar fusion procedures had no increased short-term morbidity or mortality; however, duration of surgery was 20 minutes longer on average for overlapping operations. Further studies should assess long-term patient outcomes and the impact of overlap in this and other surgical procedures.

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Decompressive lumbar laminectomy for spinal stenosis

Journal of Neurosurgery ◽

10.3171/jns.1993.78.5.0695 ◽

1993 ◽

Vol 78 (5) ◽

pp. 695-701 ◽

Cited By ~ 103

Author(s):

H. Roy Silvers ◽

P. Jeffrey Lewis ◽

Harold L. Asch

Keyword(s):

Pain Relief ◽

Spinal Stenosis ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Age Groups ◽

Normal Activity ◽

Short Term ◽

Content Type ◽

Fine Print

✓ A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery. The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.

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Primary and Revision Posterior Lumbar Fusion Have Similar Short-Term Complication Rates

Spine ◽

10.1097/brs.0000000000001094 ◽

2016 ◽

Vol 41 (2) ◽

pp. E101-E106 ◽

Cited By ~ 9

Author(s):

Bryce A. Basques ◽

Pablo J. Diaz-Collado ◽

Benjamin J. Geddes ◽

Andre M. Samuel ◽

Adam M. Lukasiewicz ◽

...

Keyword(s):

Lumbar Fusion ◽

Complication Rates ◽

Short Term ◽

Posterior Lumbar Fusion

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The Association of Preoperative Opioid Usage With Patient-Reported Outcomes, Adverse Events, and Return to Work After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽

10.1093/neuros/nyz423 ◽

2019 ◽

Vol 87 (1) ◽

pp. 142-149 ◽

Cited By ~ 1

Author(s):

Hesham Mostafa Zakaria ◽

Tarek R Mansour ◽

Edvin Telemi ◽

Karam Asmaro ◽

Michael Bazydlo ◽

...

Keyword(s):

Adverse Events ◽

Return To Work ◽

Spine Surgery ◽

Lumbar Fusion ◽

Estimating Equation ◽

Opioid Use ◽

Short Term ◽

Spine Registry ◽

Patient Reported ◽

Opioid Users

Abstract BACKGROUND It is important to delineate the relationship between opioid use and spine surgery outcomes. OBJECTIVE To determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry. METHODS Preoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (<6 wk), short-term users (6 wk-3 mo), intermediate-term users (3-6 mo), and chronic users (>6 mo). Multivariate generalized estimating equation models were constructed. RESULTS All comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P = .001), 1 yr (RR 0.89, P = .001), and 2 yr (RR 0.89, P = .005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P < .001), 1 yr (RR 1.17, P < .001), and 2 yr (RR 1.19, P = .002). Short-term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P < .001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P = .004), 1 yr (RR 0.85, P < .001), and 2 yr (RR 0.80, P = .003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P < .001). CONCLUSION In lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.

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Conceptual short-term memory (CSTM) supports core claims of Christiansen and Chater

Behavioral and Brain Sciences ◽

10.1017/s0140525x15000928 ◽

2016 ◽

Vol 39 ◽

Author(s):

Mary C. Potter

Keyword(s):

Working Memory ◽

Rapid Serial Visual Presentation ◽

Language Comprehension ◽

Short Term Memory ◽

Visual Presentation ◽

Long Term Memory ◽

Short Term ◽

Term Memory ◽

Use Of Knowledge

AbstractRapid serial visual presentation (RSVP) of words or pictured scenes provides evidence for a large-capacity conceptual short-term memory (CSTM) that momentarily provides rich associated material from long-term memory, permitting rapid chunking (Potter 1993; 2009; 2012). In perception of scenes as well as language comprehension, we make use of knowledge that briefly exceeds the supposed limits of working memory.

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Ultrastructural Changes of Canine Kidneys During 24-Hour Perfusion on a LI-400 Preservation System

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100065626 ◽

1971 ◽

Vol 29 ◽

pp. 316-317

Author(s):

M. O. Magnusson ◽

D. G. Osborne ◽

T. Shimoji ◽

W. S. Kiser ◽

W. A. Hawk

Keyword(s):

Electron Microscopy ◽

Electrolyte Solution ◽

Ultrastructural Changes ◽

Midline Incision ◽

Short Term ◽

Pentobarbital Anesthesia ◽

Pulsatile Perfusion

Short term experimental and clinical preservation of kidneys is presently best accomplished by hypothermic continuous pulsatile perfusion with cryoprecipitated and millipore filtered plasma. This study was undertaken to observe ultrastructural changes occurring during 24-hour preservation using the above mentioned method.A kidney was removed through a midline incision from healthy mongrel dogs under pentobarbital anesthesia. The kidneys were flushed immediately after removal with chilled electrolyte solution and placed on a LI-400 preservation system and perfused at 8-10°C. Serial kidney biopsies were obtained at 0-½-1-2-4-8-16 and 24 hours of preservation. All biopsies were prepared for electron microscopy. At the end of the preservation period the kidneys were autografted.

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Polychlorinated biphenyl induced hepatocyte alterations

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010012789x ◽

1987 ◽

Vol 45 ◽

pp. 716-717

Author(s):

D.N. Collins ◽

J.N. Turner ◽

K.O. Brosch ◽

R.F. Seegal

Keyword(s):

Lipid Droplets ◽

Wistar Rats ◽

Homovanillic Acid ◽

Polychlorinated Biphenyl ◽

Corn Oil ◽

Environmental Pollutants ◽

Short Term ◽

Pcb Congeners ◽

Urinary Levels ◽

The Brain

Polychlorinated biphenyls (PCBs) are a ubiquitous class of environmental pollutants with toxic and hepatocellular effects, including accumulation of fat, proliferated smooth endoplasmic recticulum (SER), and concentric membrane arrays (CMAs) (1-3). The CMAs appear to be a membrane storage and degeneration organelle composed of a large number of concentric membrane layers usually surrounding one or more lipid droplets often with internalized membrane fragments (3). The present study documents liver alteration after a short term single dose exposure to PCBs with high chlorine content, and correlates them with reported animal weights and central nervous system (CNS) measures. In the brain PCB congeners were concentrated in particular regions (4) while catecholamine concentrations were decreased (4-6). Urinary levels of homovanillic acid a dopamine metabolite were evaluated (7).Wistar rats were gavaged with corn oil (6 controls), or with a 1:1 mixture of Aroclor 1254 and 1260 in corn oil at 500 or 1000 mg total PCB/kg (6 at each level).

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