scholarly journals Second opinion in spine surgery: A scoping review

2021 ◽  
Vol 12 ◽  
pp. 436
Author(s):  
Sandra Gattas ◽  
Gianna M. Fote ◽  
Nolan J. Brown ◽  
Brian V. Lien ◽  
Elliot H. Choi ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Economic Value ◽  
Second Opinion ◽  
Inclusion Criteria ◽  
Substantial Impact ◽  
The Past ◽  
Number Of Patients ◽  
Extent Of Surgery ◽  
The Impact

Background: As a growing number of patients seek consultations for increasingly complex and costly spinal surgery, it is of both clinical and economic value to investigate the role for second opinions (SOs). Here, we summarized and focused on the shortcomings of 14 studies regarding the role and value of SOs before proceeding with spine surgery. Methods: Utilizing PubMed, Google Scholar, and Scopus, we identified 14 studies that met the inclusion criteria that included: English, primary articles, and studies published in the past 20 years. Results: We identified the following findings regarding SO for spine surgery: (1) about 40.6% of spine consultations are SO cases; (2) 61.3% of those received a discordant SO; (3) 75% of discordant SOs recommended conservative management; and (4) SO discordance applied to a variety of procedures. Conclusion: The 14 studies reviewed regarding SOs in spine surgery showed that half of the SOs differed from those given in the initial consultation and that SOs in spine surgery can have a substantial impact on patient care. Absent are prospective studies investigating the impact of following a first versus second opinion. These studies are needed to inform the potential benefit of universal implementation of SOs before major spine operations to potentially reduce the frequency and type/extent of surgery.

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.

scholarly journals The impact of lower urinary tract symptomatology on urine volumes in stone formers

2018 ◽  
Vol 13 (8) ◽  
Author(s):  
Nathan Y. Hoy ◽  
Nick S. Dean ◽  
Jeremy Wu ◽  
Timothy A. Wollin ◽  
Shubha K. De
Keyword(s):  
Urinary Tract ◽  
Urine Output ◽  
Lower Urinary Tract ◽  
Urine Volume ◽  
Urine Collection ◽  
Inclusion Criteria ◽  
Stone Formers ◽  
Number Of Patients ◽  
The Impact ◽  
Lower Urinary

Introduction: We aimed to determine if there is a correlation between International Prostate Symptom scores (IPSS) and 24-hour urine collection volumes, as patients experiencing lower urinary tract symptoms (LUTS) may have impaired ability to increase fluid intake for stone prevention.Methods: We conducted a single-centre, retrospective review was performed of stone-formers presenting from 2014‒2016. Inclusion criteria were completion of an IPSS questionnaire and a 24-hour urine collection. Exclusion criteria included symptomatic stone or urinary tract infection at time of IPSS completion, inadequate 24-hour collection, or incomplete IPSS questionnaire.Results: A total of 131 patients met inclusion criteria. Stratification by IPSS severity into mild (0‒7), moderate (8‒19), and severe (20‒35) yielded groups of n=96, 28, and 7, respectively. Linear regression modelling did not reveal a correlation between IPSS score and volume (p=0.10). When compared to those with adequate urine volumes (>2 L/day, n=65), low-volume patients (<1 L/day, n=10) had a significantly higher total IPSS (11.7 vs. 6.1; p=0.036). These groups showed significant differences in their responses to questions about incomplete emptying (p=0.031), intermittency (p=0.011), and stranguria (p=0.0020), with higher scores noted in the low urine output group.Conclusions: This study is the first to examine the correlation between IPSS and 24-hour urine volume. Though our data does not show a linear relationship between urine output and IPSS, those with lower urine volumes appear to have worse self-reported voiding symptoms when compared to those with adequate volumes (>2 L/day) for stone prevention. The overall number of patients in our study is relatively small, which may account for the lack of a relationship between IPSS and 24-hour urine volumes.

scholarly journals Perception of Local Communities Towards the Conservation Terubok

2019 ◽  
Vol 9 (3) ◽  
pp. 143
Author(s):  
Nur Athirah Bakeri ◽  
Dayang Affizzah Awang Marikan ◽  
Amin Mahir Abdullah
Keyword(s):  
Positive Attitude ◽  
Local Community ◽  
Government Intervention ◽  
Economic Value ◽  
Local Communities ◽  
Public Understanding ◽  
The Past ◽  
Almost All ◽  
The Impact ◽  
Conservation Interventions

Terubok is one of the famous, important commercially fish in Malaysia and has high economic value which only can be found in Sarawak rivers. However, this species has been threatened in the past 15 years due to heavy exploitation. Hence, this study was done to examine the perceptions of local in conserving and sustaining the terubok population. An attitudinal study is increasingly being adopted as tools for evaluating public understanding, acceptance and the impact of conservation interventions. This study examines the perception and views of local community towards the dynamic resources, government intervention, unique features and livelihood sustainability which acts as a basis on conserving terubok. The findings of these studies show that almost all of the respondents show a highly positive attitude towards conserving terubok. Local community are really well aware with the importance of terubok. Hence, this study has proof that the local community has a positive attitude towards conserving terubok.

Incidence and Characteristics of Spinal Decompression Surgery after the Onset of Symptoms of Amyotrophic Lateral Sclerosis

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 984-989 ◽  
Author(s):  
Daniel Yoshor ◽  
Arnett Klugh ◽  
Stanley H. Appel ◽  
Lanny J. Haverkamp
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Symptom Onset ◽  
Spinal Surgery ◽  
Foot Drop ◽  
Spinal Decompression ◽  
Sporadic Als ◽  
Number Of Patients ◽  
Als Patients ◽  
The Impact ◽  
Lateral Sclerosis

Abstract OBJECTIVE: The high incidence of spondylosis in patients at the mean age of onset (55.7 yr) of amyotrophic lateral sclerosis (ALS) can make recognition of ALS as a cause of weakness difficult. METHODS: To assess the impact of this diagnostic dilemma on neurosurgical practice, we performed a retrospective analysis of a database of more than 1500 patients with motor neuron disease. RESULTS: Of 1131 patients with typical, sporadic ALS, 47 (4.2%) underwent decompressive spinal surgery after the onset of retrospectively recognized symptoms of ALS. Among 55 operations in 47 ALS patients, 86% yielded no improvement, 9% produced minor improvement, and only 5% provided significant benefit. Cervical decompression was performed in 56%, lumbar in 42%, and thoracic in 2%. Foot drop was a symptom prompting surgery in 11 patients, and in 10, this finding was subsequently attributed solely to ALS. No differences between ALS patients who underwent spinal decompression and other ALS patients were noted regarding age at symptom onset, severity of impairment at time of diagnosis, or rate of disease progression. Not surprisingly, patients who had spinal surgery tended to have a longer interval between retrospectively recognized symptom onset and diagnosis of ALS. CONCLUSION: A small but significant number of patients with unrecognized ALS undergo spinal surgery that in retrospect may be inappropriate. The possibility of ALS must be considered in the evaluation of patients with weakness even in the presence of radiographic evidence of spondylosis and nerve root or spinal cord impingement.

scholarly journals Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ji Young Park ◽  
Ye Jin Lee ◽  
Taehee Kim ◽  
Chang Youl Lee ◽  
Hwan Il Kim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Diagnosis ◽  
Rapid Progression ◽  
Lung Cancers ◽  
The Past ◽  
Lung Cancer Diagnosis ◽  
Number Of Patients ◽  
Wide Range ◽  
Collateral Effects ◽  
The Impact

Abstract Background The COVID-19 pandemic is predicted to significantly affect patients with lung cancer, owing to its rapid progression and high mortality. Studies on lung cancer diagnosis and treatment during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in Korea, where lung cancer incidence continues to rise. Methods The number of newly diagnosed lung cancer cases in three university-affiliated hospitals during the pandemic and their clinical features were compared with lung cancer cases diagnosed during the same period in the past 3 years. The effectiveness of measures taken by the study hospitals to prevent nosocomial transmission was reviewed. Results A total of 612 patients were diagnosed with lung cancer from February through June, 2017–2020. During the pandemic, the number of patients who sought consultation at the division of pulmonology of study hospitals dropped by 16% from the previous year. Responding to the pandemic, the involved hospitals created physically isolated triage areas for patients with acute respiratory infection symptoms. Wide-range screening and preventive measures were implemented, thus minimizing the delay in lung cancer diagnosis. No patient acquired COVID-19 due to hospital exposure. The proportion of patients with stage III–IV non-small-cell lung cancer (NSCLC) significantly increased (2020: 74.7% vs. 2017: 57.9%, 2018: 66.7%, 2019: 62.7%, p = 0.011). The number of lung cancers diagnosed during this period and the previous year remained the same. Conclusions The proportion of patients with advanced NSCLC increased during the COVID-19 pandemic.

scholarly journals The Technological Development of Minimally Invasive Spine Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Laura A. Snyder ◽  
John O'Toole ◽  
Kurt M. Eichholz ◽  
Mick J. Perez-Cruet ◽  
Richard Fessler
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Technological Development ◽  
Case Reports ◽  
Minimally Invasive Spine Surgery ◽  
Large Field ◽  
The Past ◽  
Wide Range ◽  
Minimally Invasive Spine

Minimally invasive spine surgery has its roots in the mid-twentieth century with a few surgeons and a few techniques, but it has now developed into a large field of progressive spinal surgery. A wide range of techniques are now called “minimally invasive,” and case reports are submitted constantly with new “minimally invasive” approaches to spinal pathology. As minimally invasive spine surgery has become more mainstream over the past ten years, in this paper we discuss its history and development.

Impact of Biomechanics Research on Society

2012 ◽  
Vol 1 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Ronald F. Zernicke ◽  
Grant C. Goulet ◽  
Peter R. Cavanagh ◽  
Benno M. Nigg ◽  
James A. Ashton-Miller ◽  
...  
Keyword(s):  
Visual Arts ◽  
Pelvic Floor Dysfunction ◽  
Osteoporotic Fractures ◽  
Human Locomotion ◽  
Skeletal Growth ◽  
Musculoskeletal Health ◽  
Substantial Impact ◽  
The Past ◽  
Impact Forces ◽  
The Impact

As a field, biomechanics comprises research from the molecular and cellular levels, to tissues, to organs, to organisms and their movements. In the past 50 years, the impact of biomechanics research on society has been amplified dramatically. Here, we provide five brief summaries of exemplar biomechanics results that have had substantial impact on health and our society, namely 1) spaceflight and microgravitational effects on musculoskeletal health; 2) impact forces, soft tissue vibrations, and skeletal muscle tuning affecting human locomotion; 3) childbirth mechanics, injuries, and pelvic floor dysfunction; 4) prescriptive physical activity in childhood to enhance skeletal growth and development to prevent osteoporotic fractures in adulthood and aging; and 5) creative innovations in technology that have transformed the visual arts and entertainment.

scholarly journals The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yahya Othman ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION The purpose of this study is to compile data presented in literature regarding the efficacy of incorporating NSAIDs in the postoperative course for patients undergoing spine surgery, in particular its impact on pain levels, opioid use, complications, and hospital length of stay METHODS This is a meta-analysis and systematic review. A literature search was conducted using the backbone search [spinal surgery] [Nsaid] [complications]. Criteria for inclusion are as follows: use of NSAIDs for postoperative pain management of spinal surgery, comparison between NSAID and NSAID-free cohort, and reporting on any of pain scores, hospital opioid use, hospital length of stay, complications rate, and operative outcomes. RESULTS Out of 799 studies, 19 studies met the inclusion criteria. A total of 1522 patient were included in this analysis. The studies included randomized controlled trials, Prospective and retrospective cohorts. Operations included discectomies, laminectomies, and fusions. Most commonly regimens included the NSAID Ketorelac, as in injection given immediately postoperatively. Patients that received NSAID analgesia postoperatively had significantly lower VAS pain scores at 1 and 12 h postoperatively. This group also had a significantly lower opioid consumption and shorter hospital length of stay. A total of 7 fusion studies reported on arthrodesis, showing a significantly lower odds of fusion after NSAIDs use, however after subgrouping according to smoking, this difference proves to be no longer significant. CONCLUSION Incorporation of NSAIDs into the postoperative regimen for analgesia in patients undergoing spine surgery is an effective approach in reducing hospital length of stay, patient reported pain scores, hospital opioid use, and has no increased risk of complications. Furthermore, use of NSAIDs in the nonsmoking population does not seem to affect arthrodesis rates in patients undergoing spine surgery.

scholarly journals Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 309
Author(s):  
Francesco Sessa ◽  
Monica Salerno ◽  
Cristoforo Pomara
Keyword(s):  
Middle East ◽  
Gold Standard ◽  
Therapeutic Strategies ◽  
Asian Countries ◽  
Inclusion Criteria ◽  
Gold Standard Method ◽  
Biological Features ◽  
The Past ◽  
Advanced Technologies ◽  
The Impact

In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome—Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.

scholarly journals Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on the Development of Surgical Site Infection after Spinal Surgery: A Prospective Observational Study

Neurosurgery ◽  
2021 ◽  
Author(s):  
Kyle B Mueller ◽  
Matthew D’Antuono ◽  
Nirali Patel ◽  
Gnel Pivazyan ◽  
Edward F Aulisi ◽  
...  
Keyword(s):  
Observational Study ◽  
Spine Surgery ◽  
Negative Pressure ◽  
Spinal Surgery ◽  
Prospective Observational Study ◽  
Statistical Significance ◽  
High Risk Patient ◽  
Surgical Site Infections ◽  
Pressure Therapy ◽  
The Impact

Abstract BACKGROUND Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) in spine surgery that lacks robust data. OBJECTIVE To determine the impact of a ci-NPT, as compared with a standard dressing, on the development of SSIs after spine surgery. METHODS This was a prospective observational study over a 2-yr period. Indications for surgery included degenerative disease, deformity, malignancy, and trauma. Exclusion criteria included anterior and lateral approaches to the spine, intraoperative durotomy, or use of minimally invasive techniques. SSIs up to 60 d following surgery were recorded. RESULTS A total of 274 patients were included. SSI rate was significantly lower with ci-NPT dressing (n = 118) as compared with the standard dressing (n = 156) (3.4 vs 10.9%, P = .02). There was no statistical difference in infection rate for decompression alone procedures (4.2 vs 9.1%, P = .63), but there was a statistically significant reduction with the use of a negative-pressure dressing in cases that required instrumentation (3.2 vs 11.4%, P = .03). Patients at higher risk (instrumentation, deformity, and malignancy) had less SSIs with the use of ci-NPT, although this did not reach statistical significance. There were no complications in either group. CONCLUSION SSI rates were significantly reduced with a ci-NPT dressing vs a standard dressing in patients who underwent spinal surgery. The higher cost of a ci-NPT dressing might be justified with instrumented cases, as well as with certain high-risk patient populations undergoing spine surgery, given the serious consequences of an infection.

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