scholarly journals Spine surgery in children: past, present and future

2021 ◽  
Vol 18 (1) ◽  
pp. 78-85
Author(s):  
J. Dubousset
Keyword(s):  
Spine Surgery ◽  
Dynamic Balance ◽  
Pedicle Screws ◽  
Intervertebral Discs ◽  
Good Choice ◽  
Bone Block ◽  
Surgical Interventions ◽  
Surgical Fusion ◽  
Number Of Patients ◽  
The Future

In accordance with almost 55 years of experience in pediatric spine surgery, it is easy for me to describe the evolution of surgical technique, as well as indications for surgical interventions that were initially performed without the use of any instrumentation (which now are still occasionally considered as useful) through the anterior and posterior approaches, and with postoperative immobilization with plaster braces. The first types of really effective instrumentations were created sequentially by Harrington and Luque, and in parallel with their development, the pedicle screws (Roy-Camille) were introduced into practice. We had to wait another 20 years before the segmental 3D strategy and CD instrumentation appeared, which remain the basis of  modern spinal technologies to this day, regardless of the type of anchoring elements (hooks, screws, universal clamps or hybrid structures). For the present and the future, early interventions remain indicated for local pathological foci, which are usually the result of congenital anomalies with or without spinal cord compression. But for extended deformities, especially of thoracic localization, plaster and removable braces remain a good choice, regardless of the etiology and the presence or absence of pelvic tilt. When such methods did not give the desired result, a lot of efforts were made using various technologies to preserve the growth potentials of the spinal column without impairing respiratory function. At the same time, it was obvious that the incidence of complications was high, and the need for a final fusion was often stated. Hence the emergence of bipolar minimally invasive technologies with very promising results and significant number of patients who developed a spontaneous bone block, made the fusion surgery meaningless. As for older children and adolescents, the race to achieve maximum Cobb angle correction is becoming more controversial. It has been convincingly shown that it is much more important for the future, from the point of view of spinal function, to achieve 3D dynamic balance, which is determined by intervertebral discs located cranial and caudal to the area of surgical fusion.

Assessing variability in surgical decision making among attending neurosurgeons at an academic center

2020 ◽  
Vol 132 (6) ◽  
pp. 1970-1976
Author(s):  
Ashwin G. Ramayya ◽  
H. Isaac Chen ◽  
Paul J. Marcotte ◽  
Steven Brem ◽  
Eric L. Zager ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Repeated Measures ◽  
Elective Surgery ◽  
Statistical Tests ◽  
Neurosurgical Procedures ◽  
P Values ◽  
Surgical Interventions ◽  
Radiology Reports ◽  
Operative Notes ◽  
First Time

OBJECTIVEAlthough it is known that intersurgeon variability in offering elective surgery can have major consequences for patient morbidity and healthcare spending, data addressing variability within neurosurgery are scarce. The authors performed a prospective peer review study of randomly selected neurosurgery cases in order to assess the extent of consensus regarding the decision to offer elective surgery among attending neurosurgeons across one large academic institution.METHODSAll consecutive patients who had undergone standard inpatient surgical interventions of 1 of 4 types (craniotomy for tumor [CFT], nonacute redo CFT, first-time spine surgery with/without instrumentation, and nonacute redo spine surgery with/without instrumentation) during the period 2015–2017 were retrospectively enrolled (n = 9156 patient surgeries, n = 80 randomly selected individual cases, n = 20 index cases of each type randomly selected for review). The selected cases were scored by attending neurosurgeons using a need for surgery (NFS) score based on clinical data (patient demographics, preoperative notes, radiology reports, and operative notes; n = 616 independent case reviews). Attending neurosurgeon reviewers were blinded as to performing provider and surgical outcome. Aggregate NFS scores across various categories were measured. The authors employed a repeated-measures mixed ANOVA model with autoregressive variance structure to compute omnibus statistical tests across the various surgery types. Interrater reliability (IRR) was measured using Cohen’s kappa based on binary NFS scores.RESULTSOverall, the authors found that most of the neurosurgical procedures studied were rated as “indicated” by blinded attending neurosurgeons (mean NFS = 88.3, all p values < 0.001) with greater agreement among neurosurgeon raters than expected by chance (IRR = 81.78%, p = 0.016). Redo surgery had lower NFS scores and IRR scores than first-time surgery, both for craniotomy and spine surgery (ANOVA, all p values < 0.01). Spine surgeries with fusion had lower NFS scores than spine surgeries without fusion procedures (p < 0.01).CONCLUSIONSThere was general agreement among neurosurgeons in terms of indication for surgery; however, revision surgery of all types and spine surgery with fusion procedures had the lowest amount of decision consensus. These results should guide efforts aimed at reducing unnecessary variability in surgical practice with the goal of effective allocation of healthcare resources to advance the value paradigm in neurosurgery.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

scholarly journals Endoscopic Spine Surgery: Current State of Art and the Future Perspective

2018 ◽  
Vol 12 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Andrew Seok Min Moon ◽  
Sakthivel Rajan Rajaram Manoharan
Keyword(s):  
Spine Surgery ◽  
Future Perspective ◽  
Endoscopic Spine Surgery ◽  
Current State ◽  
The Future ◽  
State Of Art

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

Ninety-day complication, revision, and readmission rates for current-generation robot-assisted thoracolumbar spinal fusion surgery: results of a multicenter case series

2021 ◽  
pp. 1-8
Author(s):  
Jason I. Liounakos ◽  
Asham Khan ◽  
Karen Eliahu ◽  
Jennifer Z. Mao ◽  
Christopher R. Good ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Revision Surgery ◽  
Readmission Rate ◽  
Revision Rate ◽  
Case Series ◽  
Pedicle Screws ◽  
Robot Assisted ◽  
Readmission Rates ◽  
Current Generation ◽  
Guidance Systems

OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.

Big data registries in spine surgery research: the lurking dangers

2020 ◽  
pp. bmjebm-2019-111333
Author(s):  
Chad F Claus ◽  
Evan Lytle ◽  
Daniel A Carr ◽  
Doris Tong
Keyword(s):  
Big Data ◽  
Clinical Practice ◽  
Spine Surgery ◽  
Easy Access ◽  
Inappropriate Use ◽  
Number Of Patients ◽  
Surgery Research ◽  
National Databases ◽  
Proper Interpretation ◽  
Quality Evidence

Spine surgery research has improved considerably over the last few decades. Its’ most recent growth is in large part due to the mounting increase in studies conducted using national databases and registries. With easy access to a large number of patients, the benefit of these registries has become evident. However, as with any research, this type of data must be used responsibly with the appropriate strengths and limitations kept in mind. Inappropriate use of these registries continues to be a growing concern as potentially false or inaccurate conclusions can adversely impact clinical practice. It is, therefore, the author and the readers’ responsibility to acknowledge and understand the limitations of this type of data. Knowledge of methodological requirements in the use and analyses of registry data is essential to ensuring quality evidence with proper interpretation.

The challenge of stent placement within cannulation zones of Arteriovenous Fistulae

2020 ◽  
pp. 112972982095474
Author(s):  
Alexandros Mallios ◽  
Pierre Bourquelot ◽  
William C Jennings
Keyword(s):  
Surgical Management ◽  
Stent Placement ◽  
Complete Resection ◽  
Access Management ◽  
Arteriovenous Fistulae ◽  
Surgical Interventions ◽  
The Future

Background: Stent placement in the cannulation zone of AVF is becoming alarmingly frequent and sometimes in cases where surgical management would be more appropriate. When complications arise repair can be particularly challenging. We present our experience and management of this problem. Methods: We report our experience on three patients (two females and one male, mean age 72) that were referred to our department for problems related to stents placed at the cannulation segments. Results: All patients required complex surgical interventions. In two of them maintenance of access was possible but required the use of a graft. In one complete resection of the AVF and all stents was necessary, and the patient remained on dialysis through catheter. Conclusion: Stent placement at the cannulation zones may complicate access management in the future and should be avoided if possible.

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