scholarly journals A novel approach for failed lumbar spine surgery with topical phytotherapeutic treatment: a unique case study

2018 ◽  
Vol 8 (6-s) ◽  
pp. 135-140
Author(s):  
Apurba Ganguly ◽  
Devika Ganguly
Keyword(s):  
Medicinal Plants ◽  
Spine Surgery ◽  
Curcuma Longa ◽  
Radiological Feature ◽  
Substantial Improvement ◽  
Lumbar Spine Surgery ◽  
Karnofsky Performance Scale ◽  
Womac Index ◽  
Cissus Quadrangularis ◽  
Grading Scale

Objective: The aim of the study was to treat successfully the failed Lumbar Spinal Fusion Surgery (LSFS) with topical phytotherapy within twelve-week. Methods: A male patient, aged 45years, was cripple with acute pain due to slipped disc for 4years and subsequently undergone LSFS at L4-L5 3years back. Being failed in surgery, he was treated with topical application of phytoextracts of seven medicinal plants (Cissus quadrangularis, Calotropis gigantea, Zingiber officinalis, Rosemarinus officinalis, Boswellia serratia, Curcuma longa and Withania somnifera) mixed with sesame oil and beeswax with specialized technique for twelve-week. Results:  The percentages of improvement in international-approved pain related abnormalities and overweight were observed after post-treatment: Visual Analogue Scale (VAS) (Right leg: 94.91, Left leg: 94.87  and Lower back: 93.62), WOMAC index  (Pain: 88.23, Stiffness: 84.71 and Physical function: 74.07), Oswestry Disability index (ODI) (74.47), Lower Extremity Functional Scale (LEFS) (62.50), Karnofsky Performance Scale (KPS) (80.00) and Body Mass Index (BMI) (11.93) and substantial improvement in radiological images as assessed by KL grading scale (≥ 2). Conclusion: Results showed the failed LSFS at L4-L5 can be successfully treated with specialized topical phytotherapy within twelve-week, evidenced by normalization of international acclaimed pain parameters such as VAS, WOMAC index, ODI, LEFS, KPS and BMI and radiological feature as assessed by KL grading scale. Key word: Intervertebral disc degeneration; Failed spine surgery; Phytoextracts; Phytotherapy for failed LSFS;  Medicinal plants

scholarly journals Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale

2017 ◽  
Vol 27 (4) ◽  
pp. 382-390 ◽  
Author(s):  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Silky Chotai ◽  
Deborah Pfortmiller ◽  
Jeffrey M. Sorenson ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Hospital Readmission ◽  
Inpatient Rehabilitation ◽  
Lumbar Spine Surgery ◽  
Day Hospital ◽  
Data Set ◽  
Inpatient Facility ◽  
Grading Scale

OBJECTIVEExtended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies.METHODSThe Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0–12 points), discharge to inpatient facility (0–18 points), and 90-day readmission (0–6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic).RESULTSA total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System class > III, Oswestry Disability Index score ≥ 70, diabetes, Medicare/Medicaid, nonindependent ambulation, and fusion. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and readmission in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups.CONCLUSIONSThe authors introduce the Carolina-Semmes grading scale that effectively stratifies the risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission for patients undergoing first-time elective 1- to 3-level degenerative lumbar spine surgery. This grading scale may be helpful in identifying patients who may require additional resource utilization within a global period after surgery.

116 Navigating Risk in a Capitated or Bundled Payment Model for Spine Surgery: Introduction of the Carolina - Semmes Prediction Tool

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 224-225
Author(s):  
Matthew J McGirt ◽  
Scott L Parker ◽  
Silky Chotai ◽  
Deborah Pfortmiller ◽  
Jeffrey M Sorenson ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Spine Surgery ◽  
Hospital Readmission ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Inpatient Rehabilitation ◽  
Lumbar Spine Surgery ◽  
Day Hospital ◽  
Inpatient Facility ◽  
Grading Scale

Abstract INTRODUCTION Extended length of hospital stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation following spine surgery contribute significantly to variation in surgical healthcare cost. As novel payment models shift, the risk of cost over runs from payers to providers, understanding patient-level risk of these events is critical. We set out to develop a grading scale that stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. METHODS 6921 cases prospectively enrolled into the QOD registry were queried (elective 1–3 level lumbar surgery for degenerative pathology). The association between pre-operative patient variables and extended LOS( = 7 days), discharge status (inpatient facility vs. home), and 90-day hospital readmission were assessed by step-wise multivariate logistic regression. Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0-8 points), discharge to inpatient facility (0-10 points), and 90-day re-admission (0-8), its performance was assessed in the QOD dataset and then confirmed separately after applying to the Carolina Neurosurgery & Spine Associates[ CNSA] and Semmes-Murphy Clinic sites. RESULTS >290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility rehab, and 474 (6.8%) 90-day hospital readmission. Variables independently associated with these unplanned events in multivariate analysis were reviewed. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and re-admission in both the aggregate QOD dataset and when subsequently applied to two practice groups. CONCLUSION For patients undergoing first time elective 1–3 level degenerative lumbar spine surgery, we introduce the Carolina-Semmes grading scale that effectively stratifies risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission. This scale may be helpful in identifying high-risk patients who may benefit from preventative health services strategies and education as well as help structure capitated/bundled care contracts to minimize risk on the provider.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

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